Materiały źródłowe

• #1 Hydatidiform Mole – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459155/

  A full epidemiological understanding of hydatidiform moles necessitates further research; data indicate a higher incidence in Southeast Asia. […] This increased incidence in Asia compared to other geographical regions may be attributed to genetic differences within ethnic groups. […] Geographical correlation suggests an increased incidence of molar pregnancies at the extremes of maternal age, including patients with advancing maternal age (older than 35 years) and among adolescent pregnancies. […] The risk significantly escalates with age, increasing 5-fold in women older than 40 and 2.5-fold in those older than 35. […] Additionally, hydatidiform moles are more likely to occur in patients with a history of this condition.

• #1 Molar pregnancy | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/molar-pregnancy-2?lang=us

  Molar pregnancies are one of the common complications of gestation, estimated to occur in one of every 1000-2000 pregnancies. […] These moles can occur in a pregnant woman of any age, but the rate of occurrence is higher in pregnant women in their teens or between the ages of 40-50 years. […] There is a relatively increased prevalence in Asia (for example compared with Europe).

• #1 Gestational Trophoblastic Disease: Molar Pregnancy and Gestational Trophoblastic Neoplasia | Obgyn Key

  https://obgynkey.com/gestational-trophoblastic-disease-molar-pregnancy-and-gestational-trophoblastic-neoplasia/

  Gestational trophoblastic disease (GTD) describes a continuum of interrelated lesions that arise from abnormal proliferation of placental trophoblasts, ranging from benign hydatidiform mole to invasive mole, malignant choriocarcinoma (CCA), and placental site trophoblastic tumor (PSTT). […] Epidemiologic data for GTD are unreliable, primarily due to inconsistent case definitions, no centralized databases, and the rarity of certain forms of the disease. […] Based on available data, hydatidiform mole develops in women during their reproductive years, with an incidence that varies widely across different geographical regions. […] In North America, Australia, New Zealand, and Europe, the incidence of molar pregnancy has been reported as 0.6 to 1.1 per 1,000 pregnancies, but it is 2- to 3-fold higher in Southeast Asia and Japan (2.0 per 1,000 pregnancies).

• #1

  https://journals.lww.com/greenjournal/fulltext/2021/02000/gestational_trophoblastic_disease__current.22.aspx

  Estimates for the incidence of various types of gestational trophoblastic disease vary. In the United States, hydatidiform moles are observed in approximately 1 in 600 therapeutic abortions and 1 in 1,000-1,200 pregnancies. Women at the extremes of reproductive life are at increased risk, especially those older than age 45 years. Approximately 15-20% of patients will be treated for gestational trophoblastic neoplasia after evacuation of complete hydatidiform mole. Gestational choriocarcinoma occurs in approximately 1 in 20,000-40,000 pregnancies. Approximately 50% of choriocarcinomas present after term pregnancies, 25% after molar pregnancies, and the remainder after other gestational events. […] Currently, most women can be cured, and their reproductive function can be preserved, but it is important that the initial management and follow-up of patients be timely and appropriate. Practicing obstetrician-gynecologists are most likely to be involved in the care of women with hydatidiform moles. They should be able to manage this disease, including making the diagnosis of postmolar gestational trophoblastic neoplasia and evaluating the patient’s risk status to allow appropriate referral for treatment.

• #1 Molar pregnancy – Wikipedia

  https://en.wikipedia.org/wiki/Molar_pregnancy

  Molar pregnancies are relatively rare complications of pregnancy, occurring in approximately 1 in 1,000 pregnancies in the United States, while in Asia, the rates are considerably higher, reaching up to 1 in 100 pregnancies in countries like Indonesia. […] Complete moles carry a 24% risk, in Western countries, of developing into choriocarcinoma and a higher risk of 10-15% in Eastern countries, with an additional 15% risk of becoming an invasive mole. In contrast, incomplete moles can become invasive as well but are not associated with choriocarcinoma. […] The diagnosis is strongly suggested by ultrasound (sonogram), but definitive diagnosis requires histopathological examination. […] Patients are followed up until their serum human chorionic gonadotrophin (hCG) level has fallen to an undetectable level.

• #1 Gestational trophoblastic disease – Wikipedia

  https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease

  Overall, GTD is a rare disease. Nevertheless, the incidence of GTD varies greatly between different parts of the world. The reported incidence of hydatidiform mole ranges from 23 to 1299 cases per 100,000 pregnancies. The incidence of the malignant forms of GTD is much lower, only about 10% of the incidence of hydatidiform mole. […] The reported incidence of GTD from Europe and North America is significantly lower than the reported incidence of GTD from Asia and South America. […] One proposed reason for this great geographical variation is differences in healthy diet in the different parts of the world (e.g., carotene deficiency). […] However, the incidence of rare diseases (such as GTD) is difficult to measure, because epidemiologic data on rare diseases is limited. Not all cases will be reported, and some cases will not be recognised. In addition, in GTD, this is especially difficult, because one would need to know all gestational events in the total population. Yet, it seems very likely that the estimated number of births that occur at home or outside of a hospital has been inflated in some reports.

• #1 FAQs – Charing Cross Gestational Trophoblast Disease Service

  https://www.hmole-chorio.org.uk/frequently-asked-questions/

  How does the surveillance programme work? […] In the UK all cases of molar pregnancy should be registered for hCG (pregnancy test hormone) based follow-up. The gynaecology team that looks after you when the diagnosis of the molar pregnancy is made will do this. There are three centres for follow up of molar pregnancy in the UK, at Charing Cross Hospital in London, Weston Park Hospital in Sheffield and Ninewells Hospital in Dundee. […] After a molar pregnancy the level of the hCG gives an accurate measure of the number of abnormal cells left and a rising hCG level after the evacuation is a pointer that further treatment is likely to be needed. […] Although some studies have linked molar pregnancy with dietary or genetic factors, the real cause of molar pregnancy is still unknown. Molar pregnancies appear to be more common at the beginning and end of the reproductive age group. Compared to women aged between 20 and 40 the risk for girls under 15 who get pregnancy is approximately 1.5 times higher and for women aged over 45 the risk is 20-50 times higher than for younger women. The other group who are at higher risk of having a molar pregnancy are women who have had one before. Here the risk is about 5 times higher than normal which works out as about a 1 in 100 chance of having a second molar pregnancy.

• #1 Gestational Trophoblastic Disease, (Molar Pregnancy) (423) | Right Decisions

  https://rightdecisions.scot.nhs.uk/ggc-clinical-guidelines/gynaecology/gynaecology-guidelines/guidelines-a-z-all-gynaecology-guidelines/gestational-trophoblastic-disease-molar-pregnancy-423/

  Incidence in the UK: 3:1000 Partial Molar (PHM) […] 1-3:1000 Complete Molar (CHM) […] There is a slightly increased risk of molar pregnancy in the very young (16 years 1.5 x higher incidence) and a significant increase with advanced maternal age (45 20-50 x higher incidence) […] The risk of mole is increased by 1-2% following one molar pregnancy and by 15-20% after 2 […] The risk is not decreased by a change of partner […] All women who have had a molar pregnancy enter the surveillance programme […] Generally the length of time for HCG to return to normal is less than 8 weeks […] However some patients have an elevated but falling hCG level for up to 6 months […] Such patients do not require any additional treatment […] It is advised that a further pregnancy is deferred until the end of the follow-up period as a new pregnancy may mask evidence of relapse.

• #1 Advances in the diagnosis and early management of gestational trophoblastic disease | BMJ Medicine

  https://bmjmedicine.bmj.com/content/1/1/e000321

  Gestational trophoblastic disease describes a group of rare pregnancy related disorders that span a spectrum of premalignant and malignant conditions. […] Hydatidiform mole (also termed molar pregnancy) is the most common form of this disease. […] Close monitoring of women after molar pregnancy, with regular measurement of human chorionic gonadotrophin concentrations, allows for early detection of malignancy. […] Given the rarity of the disease, clinical management and treatment is best provided in specialist centres where very high cure rates are achievable. […] The incidence of hydatidiform mole varies worldwide with rates of 1-2 per 1000 pregnancies in Europe and North America compared with 10 per 1000 pregnancies in India and Indonesia. […] The incidence of GTD in the UK is one in 714 live births but incidence varies according to ethnic group, with the highest incidence reported in women of Asian descent.

• #1 Gestational Trophoblastic Disease | Doctor

  https://patient.info/doctor/gestational-trophoblastic-disease

  Gestational trophoblastic disease epidemiology is an uncommon occurrence in the UK, with a calculated incidence of 1 in 714 live births: […] There is evidence of ethnic variation in the incidence of GTD in the UK, with women from Asia having a higher incidence compared with non-Asian women (1 in 387 versus 1 in 752 live births, respectively). […] The incidence of GTD is associated with age at conception, being higher in the extremes of age (women aged less than 15 years, 1 in 500 pregnancies; women aged more than 50 years, 1 in 8 pregnancies). […] However, these figures may under-represent the true incidence of the disease because of problems with reporting, particularly in regard to partial moles. […] GTN may develop after a molar pregnancy, a non-molar pregnancy or a live birth. The incidence after a live birth is estimated at 1 in 50 000.

• #1 What is molar pregnancy? | Gestational trophoblastic disease (GTD) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/molar-pregnancy/about

  Molar pregnancies are rare but they are the most common type of GTD. In the UK, about 1 in 590 pregnancies is a molar pregnancy. In Asian women, molar pregnancies are about twice as common as in non-Asian women. […] Many molar pregnancies are picked up during routine ultrasound scans during pregnancy. […] The most common treatment for molar pregnancy is surgery. Some women might have drug treatment.

• #1 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/254657-overview

  Hispanic women were 60% less likely to have a complete mole. […] White women had the greatest risk of partial molar pregnancy. […] Hydatidiform mole is more common at the extremes of reproductive age. Women in their early teenage or perimenopausal years are most at risk. […] Women older than 35 years have a 2-fold increase in risk. […] Women older than 40 years experience a 5- to 10-fold increase in risk compared with younger women.

• #1 Ethnic disparities in complete and partial molar pregnancy incidence: a retrospective analysis of arab and jewish women in single medical center | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-18276-5

  Molar pregnancies, encompassing complete and partial moles, represent a rare and enigmatic gestational disorder with potential ethnic variations in incidence. This study aimed to investigate relations of ethnicity with risks of complete and partial molar pregnancies within an Israeli population while accounting for age differences. […] The overall risk of molar pregnancy was 22 per 10,000 live births (95% confidence interval [CI] 1825). Among Arab women, the overall risk was 21 (95% CI 1725), and for PM and CM: 14 (95% CI 1117) and 7 (95% CI 510), respectively. Among Jewish women, the overall risk was 23 (95% CI 1829), and for PM and CM: 12 (95% CI 817) and 11 (95% CI 716), respectively. […] This study highlights ethnic differences in molar pregnancy risk within the Israeli population. Jewish ethnicity was associated with a higher risk of complete molar pregnancies, while Arab women had a significantly higher risk of partial moles. These findings underscore the need to consider ethnicity when studying gestational disorders.

• #1 Gestational Trophoblastic Disease | Choose the Right Test

  https://arupconsult.com/content/gestational-trophoblastic-disease

  Complete hydatidiform moles (CHMs), or molar pregnancies, are more common in individuals younger than 21 years and older than 35 years. The risk is even greater for individuals older than 40 years. […] The risk of a subsequent CHM increases after one molar pregnancy, although it is still low. The risk is increased significantly after two molar pregnancies, and familial recurrent hydatidiform mole syndrome (caused by NLRP7 or KHDC3L gene variants) should be suspected. […] Surveillance for GTN should occur following a molar pregnancy. hCG concentrations should be measured regularly until normalization or diagnosis of GTN. […] Patients in remission for GTN should also be under surveillance. To monitor for recurrence, these patients should have hCG levels assessed every month for 12 months following the completion of treatment. After surveillance ends, hCG testing may be considered in the presence of suspicious symptoms such as vaginal bleeding.

• #1 Gestational Trophoblastic Disease: Molar Pregnancy and Gestational Trophoblastic Neoplasia | Obgyn Key

  https://obgynkey.com/gestational-trophoblastic-disease-molar-pregnancy-and-gestational-trophoblastic-neoplasia/

  Despite this geographical variation, the risk of hydatidiform mole has not been linked to any specific ethnic or racial differences, cultural factors, or differences in reporting of hospital-based and population-based data. […] However, several studies have reported a link between molar pregnancy and socioeconomic and dietary factors, specifically, that the risk of complete molar pregnancy increases with decreased consumption of vitamin A (carotene) and animal fat. […] The two strongest risk factors for complete hydatidiform mole are maternal age and prior molar pregnancy. […] Both very young women and women over the age of 40 have a higher risk of complete molar pregnancy, with older women having a 5- to 10-fold higher risk. […] The risk of a second complete molar pregnancy is 1%, approximately 10- to 20-fold higher than the risk of molar pregnancy in the general population, and the risk of a third mole is 15% to 20%.

• #1 WHO EMRO | Short communication: Molar pregnancy and husband’s occupation: do soil and dust have any role? | Volume 14, issue 1 | EMHJ volume 14, 2008

  https://www.emro.who.int/emhj-volume-14-2008/volume-14-issue-1/article21.html

  This casecontrol study investigated the association between molar pregnancy and husbands work. […] The husbands of cases were more likely to have occupations involving physical work than non-physical work and this physical work more usually involved exposure to soil and dust. […] Among all occupations, the husbands of cases were more likely to have occupations which had exposure to soil and dust (P 0.01). […] Comparing all occupations that had exposure to soil and dust with all those who did not have this exposure (physical and non-physical) resulted in a statistically significant difference in the occurrence of molar pregnancy (P 0.001). […] The aim of the present study was to evaluate the relationship between molar pregnancy and husbands occupation and the role of soil and dust. […] The results indicate that such a relationship exists.

• #1 Gestational Trophoblastic Disease (GTD) Part I: Molar Pregnancy

  https://www.contemporaryobgyn.net/view/gestational-trophoblastic-disease-gtd-part-i-molar-pregnancy

  Epidemiology Risk Factors Incidence: USA 1/1000 South East 1/100 (Hospital) Age: 20y (2fold), 40y(10 fold) 50y (50% V.mole) Prior Molar Pregnancy Second molar: 1% – Third molar: 20%! Diet: in low fat Vit. A or carotene diet (complete mole) Contraception: COC double the incidence Previous spontaneous abortion: double the incidence Repetitive H. moles in women with different partners […] Epidemiology Risk Factors Partial moles have been linked to: Higher educational levels Smoking Irregular menstrual cycles Only male infants are among the prior live births.

• #1 Hydatidiform mole: Treatment and follow-up – UpToDate

  https://www.uptodate.com/contents/hydatidiform-mole-treatment-and-follow-up

  Hydatidiform mole (HM) is one of a group of diseases that develop from abnormal proliferation of trophoblasts and are classified as gestational trophoblastic disease (GTD). The two distinct types of HM, complete mole and partial mole, have different karyotypes, gross and microscopic histopathology, clinical presentations, and prognoses. […] Treatment involves surgical removal of the molar pregnancy followed by surveillance of serial human chorionic gonadotropin (hCG) levels to confirm resolution of disease or to identify development of gestational trophoblastic neoplasia (GTN), which includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. […] Although GTN is the invasive or metastatic form of GTD, it has an excellent cure rate with chemotherapy.

• #1 Surveillance After Treatment for a Molar Pregnancy — How Long?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50523/2019/12/27/surveillance-after-treatment-molar-pregnancy-how-long

  Optimal follow-up duration depends on whether the mole is partial or complete. […] Follow-up after treatment for molar pregnancy involves monitoring serum human chorionic gonadotropin (hCG) to identify recurrent disease (gestational trophoblastic neoplasia). […] After treatment and one normal hCG, risk for recurrent disease was 0.35% (64/18,357) for complete mole and 0.03% (5/14,864) for partial mole. […] For women with molar pregnancy and normal hCG following treatment, disease recurrence is uncommon for a complete mole (1 in 287 cases) and rare for a partial mole (1 in 2973 cases). […] For these women, the authors recommend hCG testing every 3 months for ≥12 months.

• #1 Gestational trophoblastic disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/gestational-trophoblastic-disease/

  Gestational trophoblastic disease (GTD) is a class of neoplastic conditions characterized by abnormal trophoblast-cell growth in the uterus. […] Hydatidiform moles are benign but have a malignant potential, whereas GTN are malignant lesions with a tendency to metastasize, especially to the lungs. […] Risk factors include prior molar pregnancy, patients aged 15 to 35 years, and history of miscarriage. […] The risk of malignant GTN is higher in complete mole than in partial mole. […] Monitor -hCG levels until undetectable, stable, or elevated levels are detected. […] The recurrence risk of hydatidiform mole in a subsequent pregnancy is 1.8%. […] Preeclampsia at should raise suspicion for GTD. […] The risk of progression to an invasive mole depends on the type of initial hydatidiform mole. […] Complete mole: 15-20% risk of subsequent invasive mole. […] Invasive mole is characterized by the malignant transformation of an incomplete or complete mole.

• #1 How Do I Understand My Molar Pregnancy Diagnosis? | ParentData by Emily Osterframe_1-svgframe_2-svgframe_3-svg

  https://parentdata.org/molar-pregnancy/

  Molar pregnancies are rare — about 1 in 1,000 pregnancies — but they are complicated. […] Complete molar pregnancies have a higher chance of becoming GTN (15% to 20%). Partial molar pregnancies have a lower chance of becoming GTN (1% to 5%). […] The prognosis is excellent, and nearly all women with a molar pregnancy will be able to have successful pregnancies afterward. […] One important thing to know is that after a molar pregnancy, there is a time period in which you are not supposed to get pregnant again. […] If you have the correct treatment(s) and wait the requisite time with a negative HCG, then, yes, a successful pregnancy is not only possible but likely.

• #1 Gestational Trophoblastic Disease: Molar Pregnancy and Gestational Trophoblastic Neoplasia | Obgyn Key

  https://obgynkey.com/gestational-trophoblastic-disease-molar-pregnancy-and-gestational-trophoblastic-neoplasia/

  Locally invasive GTN develops in approximately 15% of patients after molar evacuation. […] CCA occurs in 1 in 50,000 pregnancies (including term, miscarriage, abortion, or ectopic). […] CCA is 1,000 times more likely to develop after a complete molar pregnancy than after other pregnancy events, with half of all CCA cases arising from molar pregnancies. […] The risk of CCA increases in women with advanced maternal age and prior hydatidiform mole, and is higher in women of Asian, American Indian, and African American descent. […] PSTT and ETT are extremely rare forms of malignant GTD, and there are insufficient data to characterize the epidemiology or risk factors.

• #1 Diagnosis and Management of Molar Gestation

  https://www.exxcellence.org/list-of-pearls/diagnosis-and-management-of-molar-gestation/?categoryName=&searchTerms=&featured=False&bookmarked=False&sortColumn=date&sortDirection=Descending

  Molar gestation arises from villous trophoblasts in the setting of aberrant fertilization. Molar gestation comprises 2 distinct subtypes: complete moles and partial moles. Unregulated trophoblastic proliferation causes elevated concentrations of human chorionic gonadotropin (hCG), commonly exceeding 100,000 IU/L in complete moles. […] The risk of postmolar GTN is greatest in the first year, and patients should undergo surveillance with serial hCG measurement using an assay that can detect all forms of this hormone. Several different organizations have guidelines for the duration and timing of surveillance testing. The Society of Gynecologic Oncology recommends checking hCG levels weekly until normalization, and then monthly for 3 months after complete moles and 1 month after partial moles. […] Risk factors for GTN include an hCG concentration at diagnosis greater than 100,000 IU/L, excessive uterine size, theca lutein cysts, and age older than 40 years. Despite earlier diagnosis of molar gestation, the incidence of postmolar GTN has remained constant.

• #1 Surveillance for gestational trophoblastic neoplasia following molar pregnancy: A cost-effectiveness analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9941751/

  Historically, published guidelines for care following molar pregnancy recommended monitoring human chorionic gonadotropin (hCG) levels for development of gestational trophoblastic neoplasia (GTN) until normal, then for 6 months after the first normal hCG. However, there is little data underlying such recommendations, and recent evidence has demonstrated that GTN diagnosis after hCG normalization is rare. […] We sought to estimate the cost-effectiveness of alternative strategies for surveillance for GTN after hCG normalization following complete and partial molar pregnancy. […] Largely due to the rare incidence of GTN after hCG normalization following molar pregnancy, prolonged surveillance is not cost-effective under most assumptions. It would be reasonable to reduce, and potentially eliminate, current recommendations for surveillance after hCG normalization following molar pregnancy, particularly among partial moles. […] Surveillance for gestational trophoblastic neoplasia after human chorionic gonadotropin normalization following molar pregnancy is not cost-effective under most assumptions; existing recommendations could be safely reduced.

• #1 Molar Pregnancy: Gestational Trophoblastic Disease | North Bristol NHS Trust

  https://www.nbt.nhs.uk/our-services/a-z-services/gynaecology/gynaecology-patient-information/molar-pregnancy-gestational-trophoblastic-disease

  Molar pregnancy is more likely to develop in women of Asian origin, teenagers and women over 40 years. […] Molar pregnancies are rare, happening with roughly 1 case for every 600 pregnancies in the UK. […] After the initial treatment, all people with a molar pregnancy should be in a follow-up programme that monitors what is happening to any cells that remain in the womb and picks out those people that need further treatment. In the UK, all people who have a molar pregnancy are enrolled into a national surveillance programme. […] Measuring the level of hCG after removal of molar pregnancy allows the surveillance team to follow exactly what is happening with any molar pregnancy cells left in the womb. […] People on the surveillance programme will be contacted directly by Charing Cross Hospital and typically asked to send in blood and/or urine samples until hCG level has fallen to a reassuring level.

• #1 Surveillance is sufficient for women following molar pregnancy: study

  https://medicalxpress.com/news/2011-11-surveillance-sufficient-women-molar-pregnancy.html

  Surveillance is sufficient for women following molar pregnancy: study […] A study published Online First by The Lancet shows that since these hCG levels will spontaneously fall in most cases, a surveillance-only policy is appropriate and would avoid unnecessary exposure to chemotherapy and its side-effects. […] In the UK, about one to three per 1000 pregnancies are either complete or partial moles. […] Following molar pregnancies, about 10% of affected women develop gestational trophoblastic disease (GTD), indications for which include raised hCG concentrations 6 months after uterine evacuation of hydatidiform mole, even if those hCG values are falling. […] The authors proposed that a surveillance policy would be clinically acceptable if hCG values returned to normal in 75% of patients or more.

• #1 Surveillance May Be Viable Option After Molar Pregnancy

  https://www.medscape.com/viewarticle/754471

  Surveillance instead of chemotherapy might be sufficient for women after a molar pregnancy, and would prevent unnecessary exposure to the toxic effects of agents such as methotrexate. […] Molar pregnancies are more common in east Asia than in most western regions. In the United Kingdom, it is estimated that 1 to 3 per 1000 pregnancies are either complete or partial moles. […] In the United Kingdom, approximately 8% of patients with hydatidiform moles undergo chemotherapy, generally with methotrexate or dactinomycin monotherapy. Current indications for chemotherapy in gestational trophoblastic disease include elevated hCG concentrations 6 months after uterine evacuation of the hydatidiform mole, even when levels are declining. […] The authors recommend that women with persistently high hCG concentrations 6 months after evacuation should continue regular hCG monitoring rather than begin chemotherapy.

• #1 UK study shows surveillance is sufficient for women following molar pregnancy, and could prevent unnecessary exposure to chemotherapy – ecancer

  https://ecancer.org/en/news/2190-uk-study-shows-surveillance-is-sufficient-for-women-following-molar-pregnancy-and-could-prevent-unnecessary-exposure-to-chemotherapy

  UK study shows surveillance is sufficient for women following molar pregnancy, and could prevent unnecessary exposure to chemotherapy. […] Molar pregnancy is an abnormal form of pregnancy. A non-viable, fertilised egg implants in the uterus, and thereby converts normal pregnancy processes into pathological ones. […] In the UK, about one to three per 1000 pregnancies are either complete or partial moles. […] Following molar pregnancies, about 10% of affected women develop gestational trophoblastic disease (GTD), indications for which include raised hCG concentrations 6 months after uterine evacuation of hydatidiform mole, even if those hCG values are falling. […] The authors say: „Our findings suggest that the practice of close surveillance could be adopted in the knowledge that these women are not being exposed to a significantly increased risk of life-threatening gestational trophoblastic neoplasia including placental site trophoblastic tumour.”

• #1 Molar pregnancy – Wikipedia

  https://en.wikipedia.org/wiki/Molar_pregnancy

  In some women, the growth can develop into gestational trophoblastic neoplasia. For women who have complete hydatidiform mole and are at high risk of this progression, evidence suggests that giving prophylactic chemotherapy (known as P-chem) may reduce the risk of this happening. […] More than 80% of hydatidiform moles are benign. The outcome after treatment is usually excellent. Close follow-up is essential to ensure that treatment has been successful. […] In 10 to 15% of cases, hydatidiform moles may develop into invasive moles. This condition is named persistent trophoblastic disease (PTD). […] In 2 to 3% of cases, hydatidiform moles may develop into choriocarcinoma, which is a malignant, rapidly growing, and metastatic (spreading) form of cancer.

• #1 FAQs – Charing Cross Gestational Trophoblast Disease Service

  https://www.hmole-chorio.org.uk/frequently-asked-questions/

  In most patients no further treatment is needed after the evacuation and the monitoring centre watches the hCG level fall back to normal and stay there. However in approximately 10% of patients who have had a complete molar pregnancy and 1% of partial mole patients treatment is needed. The decision to start treatment is generally made on the pattern of the hCG levels following the evacuation. […] There are three treatment options for patients with persistent trophoblastic disease after a molar pregnancy. The most frequent choice is to use chemotherapy. This approach is simple, generally has few side effects and allows patients to retain their fertility. It has a cure rate of over 99%. […] Chemotherapy is continued until the hCG level reaches normal and then for a further 6 weeks after that to kill off any residual cells.

• #1 Journal Publishes ACOG-endorsed Evidence-Based Review on GTD | Society of Gynecologic Oncology

  https://www.sgo.org/news/gynecologic-oncology-publishes-acog-endorsed-evidence-based-review-on-gtd/

  Dr. Eskander added that although it is uncommon, it is important for gynecologic oncologists to be well versed in the identification and management of GTN. This is one of the rare malignancies, where despite metastatic disease, cure rates remain high with appropriate management, highlighting the relevance of this document, he said.

• #1 FAQs – Charing Cross Gestational Trophoblast Disease Service

  https://www.hmole-chorio.org.uk/frequently-asked-questions/

  How common are molar pregnancies? […] The figures for the UK in 2011 show that there were 1784 molar pregnancies registered in England and Wales and that there were 700,000 live births. From past data, this equates to around 1 molar pregnancy for every 500 babies born. This means that for each obstetric unit molar pregnancies are quite rare perhaps 1 or 2 cases per year, but for the treatment centres they are quite common with 1200 patients registered at Charing Cross and 120 treated. […] Why is it important that the diagnosis of molar pregnancy is correctly made? […] Molar pregnancies carry a risk of developing into persistent trophoblastic disease which needs further treatment most commonly with chemotherapy. Overall the risk of needing this treatment is about 1 in 10 after a complete molar pregnancy and 1 in 100 after a partial molar pregnancy. At present there is no accurate way of predicting immediately after the evacuation who will need further treatment, so it is the policy in the UK that all women who have had a molar pregnancy enter the surveillance programme.

• #1 WHO EMRO | Short communication: Molar pregnancy and husband’s occupation: do soil and dust have any role? | Volume 14, issue 1 | EMHJ volume 14, 2008

  https://www.emro.who.int/emhj-volume-14-2008/volume-14-issue-1/article21.html

  Environmental factors have been suggested as risk factors for molar pregnancy, but there are few reports about the associations between occupation and molar pregnancy. […] Further research into the association between occupation and molar pregnancy is recommended with larger samples and investigation of the spermatogenesis and fertilization processes.

• #1

  https://link.springer.com/article/10.1007/s13669-022-00327-6

  This review describes recommendations for the diagnosis and management of molar pregnancy, with focus on emerging evidence in recent years, particularly as it pertains to nuances of diagnosis, risk stratification, and surveillance of post-molar malignant trophoblastic disease. […] Topics discussed include advances in histopathologic diagnosis of molar pregnancy to standardize analysis, most recent estimations of post-molar pregnancy malignancy, and updated surveillance guidelines. […] Recent data support a reduction in the length of surveillance following normalization of human chorionic gonadotropin levels after evacuation. […] Cost-effectiveness analysis of post-molar GTN surveillance finding reduction or elimination of hCG surveillance would be cost effective and clinically reasonable given the rarity of malignant following hCG normalization. Additionally, found a single hCG test 3 months after uterine evacuation was a cost-effective alternative.

• #1 Eclampsia, HELLP and PRES in a 16-week partial molar pregnancy | BMJ Case Reports

  https://casereports.bmj.com/content/17/6/e258188

  Current management guidelines for molar pregnancy are primarily focused on evacuation of the pregnancy and rigorous beta-HCG monitoring to prevent the progression to gestational neoplasia. […] This case also supports investigative efforts to look for linkages between molar pregnancy and eclampsia to more fully uncover the aetiology of gestational hypertensive disorders.

• #1 Eclampsia, HELLP and PRES in a 16-week partial molar pregnancy | BMJ Case Reports

  https://casereports.bmj.com/content/17/6/e258188

  Eclampsia spectrum disorders are a set of serious complications of pregnancy that commonly present after 20 weeks of gestation. […] There is an association between molar pregnancy, a gestational trophoblastic disease resulting from abnormal fertilisation and gametogenesis, and eclampsia spectrum disorders which can result in manifestation of pre-eclamptic symptomatology earlier than 20 weeks of gestation. […] Although pre-eclampsia and HELLP syndrome rarely occur before 20 weeks of gestation, reports have suggested early occurrences of these hypertensive disorders specifically in the setting of a molar pregnancy. […] There is an association between pre-eclampsia and molar pregnancy. Of partial hydatidiform molar pregnancies, 41.9% will develop the symptoms of pre-eclampsia if left untreated.

• #1 UK study shows surveillance is sufficient for women following molar pregnancy, and could prevent unnecessary exposure to chemotherapy – ecancer

  https://ecancer.org/en/news/2190-uk-study-shows-surveillance-is-sufficient-for-women-following-molar-pregnancy-and-could-prevent-unnecessary-exposure-to-chemotherapy

  They conclude: „As far as we are aware, our study is the first to investigate whether continued hCG surveillance is a clinically acceptable approach as opposed to chemotherapy. Our findings directly challenge the present clinical dogma, and provide data showing that continued surveillance for women with high but falling hCG concentrations 6 months after uterine evacuation of a molar pregnancy is clinically acceptable because nearly all patients will spontaneously remit.”

• #2 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/254657-overview

  By studying elective pregnancy terminations, hydatidiform moles were determined to occur in approximately 1 in 1200 pregnancies. […] The reported frequency of hydatidiform mole varies greatly. Some of this variability can be explained by differences in methodology (eg, single hospital vs population studies, identification of cases). The reported frequencies range from 1 in 100 pregnancies in Indonesia to 1 in 200 pregnancies in Mexico to 1 in 5000 pregnancies in Paraguay. […] In the United Kingdom, the incidence of molar pregnancy is approximately 1 in 600 conceptions. […] Differences in the frequency of hydatidiform moles between ethnic groups have been reported internationally. […] In the United States, a cross-sectional study of 140 complete moles and 115 partial moles found that Asian women were more than twice as likely as White women to have a complete mole but were less likely to have a partial mole.

• #2 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/254657-overview

  Hispanic women were 60% less likely to have a complete mole. […] White women had the greatest risk of partial molar pregnancy. […] Hydatidiform mole is more common at the extremes of reproductive age. Women in their early teenage or perimenopausal years are most at risk. […] Women older than 35 years have a 2-fold increase in risk. […] Women older than 40 years experience a 5- to 10-fold increase in risk compared with younger women.

• #2 Gestational Trophoblastic Disease, (Molar Pregnancy) (423) | Right Decisions

  https://rightdecisions.scot.nhs.uk/ggc-clinical-guidelines/gynaecology/gynaecology-guidelines/guidelines-a-z-all-gynaecology-guidelines/gestational-trophoblastic-disease-molar-pregnancy-423/

  Incidence in the UK: 3:1000 Partial Molar (PHM) […] 1-3:1000 Complete Molar (CHM) […] There is a slightly increased risk of molar pregnancy in the very young (16 years 1.5 x higher incidence) and a significant increase with advanced maternal age (45 20-50 x higher incidence) […] The risk of mole is increased by 1-2% following one molar pregnancy and by 15-20% after 2 […] The risk is not decreased by a change of partner […] All women who have had a molar pregnancy enter the surveillance programme […] Generally the length of time for HCG to return to normal is less than 8 weeks […] However some patients have an elevated but falling hCG level for up to 6 months […] Such patients do not require any additional treatment […] It is advised that a further pregnancy is deferred until the end of the follow-up period as a new pregnancy may mask evidence of relapse.

• #2 Ethnic disparities in complete and partial molar pregnancy incidence: a retrospective analysis of arab and jewish women in single medical center | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-18276-5

  The incidence of PM was higher among Arab than Jewish women, in the 35-39-year age group. The incidence of CM moles was higher among Jewish than Arab women, in the 25-29-year age group, but the statistical significance of this difference was only marginal. […] In multivariate analysis, considering mole type as the dependent variable, and ethnicity and age as independent variables, ethnicity was significantly associated with the risk of a CM pregnancy. The risk of a CM was higher among Jewish than Arab women (OR=2.19, 95% CI 1.094.41, p=0.028). […] Overall, our findings suggest a possible relation between ethnicity and the risk of molar pregnancies, particularly CM. Jewish women had a higher risk of a CM than Arab women. In parallel, Arab women had a higher risk of PM after age adjustment.

• #2 Gestational Trophoblastic Disease: Molar Pregnancy and Gestational Trophoblastic Neoplasia | Obgyn Key

  https://obgynkey.com/gestational-trophoblastic-disease-molar-pregnancy-and-gestational-trophoblastic-neoplasia/

  Despite this geographical variation, the risk of hydatidiform mole has not been linked to any specific ethnic or racial differences, cultural factors, or differences in reporting of hospital-based and population-based data. […] However, several studies have reported a link between molar pregnancy and socioeconomic and dietary factors, specifically, that the risk of complete molar pregnancy increases with decreased consumption of vitamin A (carotene) and animal fat. […] The two strongest risk factors for complete hydatidiform mole are maternal age and prior molar pregnancy. […] Both very young women and women over the age of 40 have a higher risk of complete molar pregnancy, with older women having a 5- to 10-fold higher risk. […] The risk of a second complete molar pregnancy is 1%, approximately 10- to 20-fold higher than the risk of molar pregnancy in the general population, and the risk of a third mole is 15% to 20%.

• #2 WHO EMRO | Short communication: Molar pregnancy and husband’s occupation: do soil and dust have any role? | Volume 14, issue 1 | EMHJ volume 14, 2008

  https://www.emro.who.int/emhj-volume-14-2008/volume-14-issue-1/article21.html

  Environmental factors have been suggested as risk factors for molar pregnancy, but there are few reports about the associations between occupation and molar pregnancy. […] Further research into the association between occupation and molar pregnancy is recommended with larger samples and investigation of the spermatogenesis and fertilization processes.

• #2 Diagnosis and Management of Molar Gestation

  https://www.exxcellence.org/list-of-pearls/diagnosis-and-management-of-molar-gestation/?categoryName=&searchTerms=&featured=False&bookmarked=False&sortColumn=date&sortDirection=Descending

  Molar gestation arises from villous trophoblasts in the setting of aberrant fertilization. Molar gestation comprises 2 distinct subtypes: complete moles and partial moles. Unregulated trophoblastic proliferation causes elevated concentrations of human chorionic gonadotropin (hCG), commonly exceeding 100,000 IU/L in complete moles. […] The risk of postmolar GTN is greatest in the first year, and patients should undergo surveillance with serial hCG measurement using an assay that can detect all forms of this hormone. Several different organizations have guidelines for the duration and timing of surveillance testing. The Society of Gynecologic Oncology recommends checking hCG levels weekly until normalization, and then monthly for 3 months after complete moles and 1 month after partial moles. […] Risk factors for GTN include an hCG concentration at diagnosis greater than 100,000 IU/L, excessive uterine size, theca lutein cysts, and age older than 40 years. Despite earlier diagnosis of molar gestation, the incidence of postmolar GTN has remained constant.

• #2 Molar Pregnancy: Gestational Trophoblastic Disease | North Bristol NHS Trust

  https://www.nbt.nhs.uk/our-services/a-z-services/gynaecology/gynaecology-patient-information/molar-pregnancy-gestational-trophoblastic-disease

  The majority of people who have a molar pregnancy will not need any further treatment after the initial suction evacuation procedure. However, approximately 15% of people with complete molar pregnancy and around 1% with partial molar pregnancy will require additional treatment. […] The two main reasons patients need further treatment is because either the hCG level starts to rise or reaches a plateau or because there is heavy vaginal bleeding. […] Fortunately the overall cure rate for women who need treatment after a molar pregnancy is over 99%.

• #2

  https://journals.lww.com/greenjournal/fulltext/2021/02000/gestational_trophoblastic_disease__current.22.aspx

  Serial quantitative serum hCG determinations should be performed after molar evacuation using one of several commercially available assays capable of detecting -hCG to baseline values (less than 5 milli-international units/mL). For monitoring patients with gestational trophoblastic disease, an hCG assay that can detect all forms of hCG is needed because these neoplasms often secrete abnormal forms of hCG. […] The rationale for recommending an interval of monitoring after normalization of hCG value is to identify patients who develop postmolar malignant gestational trophoblastic neoplasia after achieving normal hCG values. Although rare instances of long latent periods preceding postmolar gestational trophoblastic neoplasia have been reported, almost all episodes of malignant sequelae occur within 6-12 months of evacuation. […] Patients are at heightened risk for postmolar gestational trophoblastic neoplasia if they have any of the following: age older than 40 years, pre-evacuation hCG greater than 100,000 milli-international units/mL, excessive uterine enlargement, or theca lutein cysts greater than 6 cm.

• #2 Surveillance After Treatment for a Molar Pregnancy — How Long?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50523/2019/12/27/surveillance-after-treatment-molar-pregnancy-how-long

  Optimal follow-up duration depends on whether the mole is partial or complete. […] Follow-up after treatment for molar pregnancy involves monitoring serum human chorionic gonadotropin (hCG) to identify recurrent disease (gestational trophoblastic neoplasia). […] After treatment and one normal hCG, risk for recurrent disease was 0.35% (64/18,357) for complete mole and 0.03% (5/14,864) for partial mole. […] For women with molar pregnancy and normal hCG following treatment, disease recurrence is uncommon for a complete mole (1 in 287 cases) and rare for a partial mole (1 in 2973 cases). […] For these women, the authors recommend hCG testing every 3 months for ≥12 months.

• #2 Gestational Trophoblastic Disease | Choose the Right Test

  https://arupconsult.com/content/gestational-trophoblastic-disease

  Complete hydatidiform moles (CHMs), or molar pregnancies, are more common in individuals younger than 21 years and older than 35 years. The risk is even greater for individuals older than 40 years. […] The risk of a subsequent CHM increases after one molar pregnancy, although it is still low. The risk is increased significantly after two molar pregnancies, and familial recurrent hydatidiform mole syndrome (caused by NLRP7 or KHDC3L gene variants) should be suspected. […] Surveillance for GTN should occur following a molar pregnancy. hCG concentrations should be measured regularly until normalization or diagnosis of GTN. […] Patients in remission for GTN should also be under surveillance. To monitor for recurrence, these patients should have hCG levels assessed every month for 12 months following the completion of treatment. After surveillance ends, hCG testing may be considered in the presence of suspicious symptoms such as vaginal bleeding.

• #2

  https://scholars.duke.edu/individual/pub1484608

  BACKGROUND: Historically, published guidelines for care after molar pregnancy recommended monitoring human chorionic gonadotropin levels for the development of gestational trophoblastic neoplasia until normal and then for 6 months after the first normal human chorionic gonadotropin. […] However, there are little data underlying such recommendations, and recent evidence has demonstrated that gestational trophoblastic neoplasia diagnosis after human chorionic gonadotropin normalization is rare. […] CONCLUSION: Largely owing to the rare incidence of gestational trophoblastic neoplasia after human chorionic gonadotropin normalization after molar pregnancy, prolonged surveillance is not cost-effective under most assumptions. It would be reasonable to reduce, and potentially eliminate, current recommendations for surveillance after human chorionic gonadotropin normalization after molar pregnancy, particularly among partial moles.

• #2

  https://link.springer.com/article/10.1007/s13669-022-00327-6

  This review describes recommendations for the diagnosis and management of molar pregnancy, with focus on emerging evidence in recent years, particularly as it pertains to nuances of diagnosis, risk stratification, and surveillance of post-molar malignant trophoblastic disease. […] Topics discussed include advances in histopathologic diagnosis of molar pregnancy to standardize analysis, most recent estimations of post-molar pregnancy malignancy, and updated surveillance guidelines. […] Recent data support a reduction in the length of surveillance following normalization of human chorionic gonadotropin levels after evacuation. […] Cost-effectiveness analysis of post-molar GTN surveillance finding reduction or elimination of hCG surveillance would be cost effective and clinically reasonable given the rarity of malignant following hCG normalization. Additionally, found a single hCG test 3 months after uterine evacuation was a cost-effective alternative.

• #2 FAQs – Charing Cross Gestational Trophoblast Disease Service

  https://www.hmole-chorio.org.uk/frequently-asked-questions/

  How common are molar pregnancies? […] The figures for the UK in 2011 show that there were 1784 molar pregnancies registered in England and Wales and that there were 700,000 live births. From past data, this equates to around 1 molar pregnancy for every 500 babies born. This means that for each obstetric unit molar pregnancies are quite rare perhaps 1 or 2 cases per year, but for the treatment centres they are quite common with 1200 patients registered at Charing Cross and 120 treated. […] Why is it important that the diagnosis of molar pregnancy is correctly made? […] Molar pregnancies carry a risk of developing into persistent trophoblastic disease which needs further treatment most commonly with chemotherapy. Overall the risk of needing this treatment is about 1 in 10 after a complete molar pregnancy and 1 in 100 after a partial molar pregnancy. At present there is no accurate way of predicting immediately after the evacuation who will need further treatment, so it is the policy in the UK that all women who have had a molar pregnancy enter the surveillance programme.

• #2 Surveillance is sufficient for women following molar pregnancy: study

  https://medicalxpress.com/news/2011-11-surveillance-sufficient-women-molar-pregnancy.html

  The authors say: „Our findings suggest that the practice of close surveillance could be adopted in the knowledge that these women are not being exposed to a significantly increased risk of life-threatening gestational trophoblastic neoplasia including placental site trophoblastic tumour.” […] They conclude: „As far as we are aware, our study is the first to investigate whether continued hCG surveillance is a clinically acceptable approach as opposed to chemotherapy.” […] The results are important because they will change international practice and spare women unnecessary exposure to chemotherapy and its toxic effects.

• #2 Molar pregnancy – Wikipedia

  https://en.wikipedia.org/wiki/Molar_pregnancy

  In some women, the growth can develop into gestational trophoblastic neoplasia. For women who have complete hydatidiform mole and are at high risk of this progression, evidence suggests that giving prophylactic chemotherapy (known as P-chem) may reduce the risk of this happening. […] More than 80% of hydatidiform moles are benign. The outcome after treatment is usually excellent. Close follow-up is essential to ensure that treatment has been successful. […] In 10 to 15% of cases, hydatidiform moles may develop into invasive moles. This condition is named persistent trophoblastic disease (PTD). […] In 2 to 3% of cases, hydatidiform moles may develop into choriocarcinoma, which is a malignant, rapidly growing, and metastatic (spreading) form of cancer.

• #2 Molar Pregnancy: Gestational Trophoblastic Disease | North Bristol NHS Trust

  https://www.nbt.nhs.uk/our-services/a-z-services/gynaecology/gynaecology-patient-information/molar-pregnancy-gestational-trophoblastic-disease

  Molar pregnancy is more likely to develop in women of Asian origin, teenagers and women over 40 years. […] Molar pregnancies are rare, happening with roughly 1 case for every 600 pregnancies in the UK. […] After the initial treatment, all people with a molar pregnancy should be in a follow-up programme that monitors what is happening to any cells that remain in the womb and picks out those people that need further treatment. In the UK, all people who have a molar pregnancy are enrolled into a national surveillance programme. […] Measuring the level of hCG after removal of molar pregnancy allows the surveillance team to follow exactly what is happening with any molar pregnancy cells left in the womb. […] People on the surveillance programme will be contacted directly by Charing Cross Hospital and typically asked to send in blood and/or urine samples until hCG level has fallen to a reassuring level.

• #2 The frequency of hydatidiform mole in a tertiary care hospital from central India – IJPO

  https://www.ijpo.co.in/html-article/10745

  The most sensitive and specific for diagnosis of the trophoblast-related conditions, i.e., pregnancy and the GTD is serum beta hCG. […] Follow up of such patients is crucial for early detection of malignant trophoblastic tumours and also to minimize the mortality rate. […] Because of rarity of this condition multi-centric studies are required in India to determine the true incidence and overall outcome of gestational trophoblastic diseases.

• #3 Advances in the diagnosis and early management of gestational trophoblastic disease | BMJ Medicine

  https://bmjmedicine.bmj.com/content/1/1/e000321

  In the UK, the incidence of molar pregnancy is about one in 600 conceptions and the prevalence of PHM is higher than CHM at a ratio of 3:1. […] Most women with molar pregnancy do not require further treatment following uterine evacuation of the products of conception. However, some women develop disease persistence and progress to malignant disease requiring chemotherapy or further surgical intervention. […] Potential risk factors for the development of molar pregnancy include ethnicity, maternal age, and history of a hydatidiform mole. […] The risk of a second molar pregnancy is about 1% and this risk is greater for CHM than PHM. […] Recent evidence suggests that women who have early diagnosis of PHM as their first gestational event are more likely to develop postmolar GTN. […] Women with a molar pregnancy usually present with irregular vaginal bleeding in the first trimester.

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