Early molar pregnancy: experience in a large abortion service☆

Received 10 March 2009; received in revised form 12 August 2009; accepted 20 August 2009. published online 05 October 2009.

Abstract

Background

With 1.1 million US women having first-trimester abortions annually, clinicians have an opportunity to diagnose molar pregnancy early. Early moles, however, may lack “classic” diagnostic hallmarks.

Study Design

This study aimed to assess the accuracy of the diagnosis of hydatidiform mole in women seeking abortion services at a large Planned Parenthood affiliate. We retrospectively identified women with a histopathologic diagnosis of mole from the affiliate's risk management database. The tissue specimens were reviewed by an expert independent pathologist and analyzed by flow cytometry and p57KIP2 immunohistochemical staining to clarify the diagnosis.

Results

Of 21 patients who received an initial histopathologic diagnosis of mole, only six proved to have the condition. The interobserver correlation coefficient (kappa) for pathology examination was (−) 0.353. Overdiagnosis of partial moles was the most common error.

Conclusions

Improved, cost-effective strategies for detection of early moles would benefit patients and providers.

Keywords: Hydatidiform mole, Molar pregnancy, Early hydatidiform mole, Gestational trophoblastic disease

a Planned Parenthood of New York City, New York, NY 10012, USA

b Department of Obstetrics, Gynecology and Reproductive Science, Mt. Sinai School of Medicine, New York, NY 10029, USA

c Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA 94110, USA

d Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA

e Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA

f Department of Sociology, McGill University, Montreal, Quebec H3A 2T7, Canada

g Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94110, USA

Corresponding author. Planned Parenthood of New York City, New York, NY 10012, USA.

☆ Disclaimer: The opinions expressed in this article do not necessarily reflect those of Planned Parenthood Federation of America, Inc.

PII: S0010-7824(09)00386-2

doi:10.1016/j.contraception.2009.08.007

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