Contraception
Volume 81, Issue 2 , Pages 150-156 , February 2010

Early molar pregnancy: experience in a large abortion service

  • Maureen Paul

      Affiliations

    • Planned Parenthood of New York City, New York, NY 10012, USA
    • Department of Obstetrics, Gynecology and Reproductive Science, Mt. Sinai School of Medicine, New York, NY 10029, USA
    • Corresponding Author InformationCorresponding author. Planned Parenthood of New York City, New York, NY 10012, USA.
    • ,
  • Suzan Goodman

      Affiliations

    • Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA 94110, USA
    • ,
  • Juan Felix

      Affiliations

    • Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
    • Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
    • ,
  • Rebekah Lewis

      Affiliations

    • Department of Sociology, McGill University, Montreal, Quebec H3A 2T7, Canada
    • ,
  • Mitchel Hawkins

      Affiliations

    • Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94110, USA
    • ,
  • Eleanor Drey

      Affiliations

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

Received 10 March 2009 ,Revised 12 August 2009 ,Accepted 20 August 2009.

References 

  1. Smith HO. Gestational trophoblastic disease epidemiology and trends. Clin Obstet Gynecol. 2003;46:541–556
  2. Seckl MJ, Fisher RA, Salerno G, et al. Choriocarcinoma and partial hydatidiform moles. Lancet. 2000;356:36–39
  3. Sebire NJ, Seckl MJ. Diagnosis and management of gestational trophoblastic disease. In:  Paul M,  Lichtenberg ES,  Borgatta L,  Grimes DA,  Stubblefield P,  Creinin MD editor. Management of unintended and abnormal pregnancy: Comprehensive abortion care. Oxford: Wiley-Blackwell; 2009;p. 293–301
  4. American College of Obstetricians and Gynecologists . ACOG Practice Bulletin No. 53. Diagnosis and treatment of gestational trophoblastic disease. Obstet Gynecol. 2004;103:1365–1377
  5. Jones RK, Zolna MR, Henshaw SK, Finer LB. Abortion in the United States: incidence and access to services, 2005. Perspect Sex Reprod Health. 2008;40:6–16
  6. Gamble SB, Strauss LT, Parker WY, Cook DA, Zane SB, Hamdan S. Centers for Disease Control and Prevention (CDC). Abortion surveillance — United States, 2005. MMWR Surveill Summ. 2008;57:1–32
  7. Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol. 1995;86:775–779
  8. Coukos G, Makrigiannakis A, Chung J, Randall TC, Rubin SC, Benjamin I. Complete hydatidiform mole. A disease with a changing profile. J Reprod Med. 1999;44:698–704
  9. Gemer O, Segal S, Kopmar A, Sassoon E. The current clinical presentation of complete molar pregnancy. Arch Gynecol Obstet. 2000;264:33–34
  10. Sebire NJ, Rees H, Paradinas F, Seckl M, Newlands E. The diagnostic implications of routine ultrasound examination in histologically confirmed early molar pregnancies. Ultrasound Obstet Gynecol. 2001;18:662–665
  11. Kirk E, Papageorghiou AT, Condous G, Bottomley C, Bourne T. The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole. Ultrasound Obstet Gynecol. 2007;29:70–75
  12. Berkowitz RS, Goldstein DP. Molar pregnancy. N Engl J Med. 2009;360:1639–1645
  13. Mosher R, Goldstein DP, Berkowitz R, Bernstein M, Genest DR. Complete hydatiform mole. Comparison of clinicopathological features, current and past. J Reprod Med. 1998;43:21–27
  14. Sebire NJ, Fisher RA, Rees HC. Histopathological diagnosis of partial and complete hydatidiform mole in the first trimester of pregnancy. Pediatr Dev Pathol. 2003;6:69–77
  15. Soper JT. Gestational trophoblastic disease. Obstet Gynecol. 2006;108:176–187
  16. Genest DR, Ruiz RE, Weremowicz S, Berkowitz RS, Goldstein DP, Dorfman DM. Do nontriploid partial hydatidiform moles exist? A histologic and flow cytometric reevaluation of nontriploid specimens. J Reprod Med. 2002;47:363–368
  17. Fisher RA, Lawler SD, Ormerod MG, Imrie P, Povey S. Flow cytometry used to distinguish between complete and partial hydatidiform moles. Placenta. 1987;8:249–256
  18. Fukunaga M. Flow cytometric and clinicopathologic study of complete hydatidiform moles with special reference to the significance of cytometric aneuploidy. Gynecol Oncol. 2001;81:67–70
  19. Castrillon DH, Sun D, Weremowicz S, Fisher RA, Crum CP, Genest DR. Discrimination of complete hydatidiform mole from its mimics by immunohistochemistry of the paternally imprinted gene product p57KIP2. Am J Surg Pathol. 2001;25:1225–1230
  20. Merchant SH, Amin MB, Viswanatha DS, Malhotra RK, Moehlenkamp C, Joste NE. p57KIP2 immunohistochemistry in early molar pregnancies: emphasis on its complementary role in the differential diagnosis of hydropic abortuses. Hum Pathol. 2005;36:180–186
  21. Crisp H, Burton JL, Stewart R, Wells M. Refining the diagnosis of hydatidiform mole: image ploidy analysis and p57KIP2 immunohistochemistry. Histopathology. 2003;43:363–373
  22. Shi SR, Imam SA, Young L, Cote RJ, Taylor CR. Antigen retrieval immunohistochemistry under the influence of pH using monoclonal antibodies. J Histochem Cytochem. 1995;43:193–201
  23. Shi SR, Chaiwun B, Young L, Imam SA, Cote RJ, Taylor CR. Antigen retrieval using pH 3.5 glycine-HCl buffer or urea solution for immunohistochemical localization of Ki-67. Biotech Histochem. 1994;69:213–215
  24. Newman TB, Browner WS, Cummings SR. Designing studies of medical tests. In:  Hulley SB,  Cummings SR,  Browner WS,  Grady D,  Hearst N,  Newman TB editor. Designing clinical research: an epidemiologic approach. 2nd edition. Philadelphia: Lippincott Williams & Wilkins; 2001;p. 178–193
  25. Fukunaga M, Katabuchi H, Nagasaka T, Mikami Y, Minamiguchi S, Lage JM. Interobserver and intraobserver variability in the diagnosis of hydatidiform mole. Am J Surg Pathol. 2005;29:942–947
  26. Wachtel MS. Interobserver and intraobserver variability in the diagnosis of hydatidiform mole. Am J Surg Pathol. 2005;29:1410
  27. Howat AJ, Beck S, Fox H, et al. Can histopathologists reliably diagnose molar pregnancy?. J Clin Pathol. 1993;46:599–602
  28. Lindholm H, Flam F. The diagnosis of molar pregnancy by sonography and gross morphology. Acta Obstet Gynecol Scand. 1999;78:6–9
  29. Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Routine pre-evacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center. Ultrasound Obstet Gynecol. 2006;27:56–60
  30. Feltmate CM, Batorfi J, Fulop V, Goldstein DP, Doszpod J, Berkowitz RS. Human chorionic gonadotropin follow-up in patients with molar pregnancy: a time for reevaluation. Obstet Gynecol. 2003;101:732–736
  31. Massad LS, Abu-Rustum NR, Lee SS, Renta V. Poor compliance with postmolar surveillance and treatment protocols by indigent women. Obstet Gynecol. 2000;96:940–944
  32. Seckl MJ, Gillmore R, Foskett M, Sebire NJ, Rees H, Newlands ES. Routine termination of pregnancy — should we screen for gestational trophoblastic neoplasia?. Lancet. 2004;364:705–707
  33. O'Connell K, Jones HE, Simon M, Saporta V, Paul M, Lichtenberg ES. First-trimester surgical abortion practices: a survey of National Abortion Federation members. Contraception. 2009;79:385–392
  34. Paul M, Lackie E, Mitchell C, Rogers A, Fox M. Is pathology examination useful after early surgical abortion?. Obstet Gynecol. 2002;99:567–571
  35. Piura B. Women undergoing termination of pregnancy should be screened for gestational trophoblastic neoplasia. Lancet. 2004;364:645–646
  36. Ofinran O, Papaioannou S, Kandavel V, Shrivastava S, Hall S, Tzafettas J. Negative pregnancy test: Could it be a molar pregnancy?. J Obstet Gynaecol. 2007;27:857–858
  37. Sebire NJ, Makrydimas G, Agnantis NJ, Zagorianakou N, Rees H, Fisher RA. Updated diagnostic criteria for partial and complete hydatidiform moles in early pregnancy. Anticancer Res. 2003;23:1723–1728
  38. Wolfberg AJ, Feltmate C, Goldstein DP, Berkowitz RS, Lieberman E. Low risk of relapse after achieving undetectable hCG levels in women with complete molar pregnancy. Obstet Gynecol. 2004;104:551–554
  39. Wolfberg AJ, Growdon WB, Feltmate CM, et al. Low risk of relapse after achieving undetectable hCG levels in women with partial molar pregnancy. Obstet Gynecol. 2006;108:393–396

☆ 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

Contraception
Volume 81, Issue 2 , Pages 150-156 , February 2010

Article Tools