Reduction of postmolar gestational trophoblastic neoplasia by early diagnosis and treatment

OBJECTIVE: To compare contemporary and historical clinical presentation of complete moles (CMs) and the rates of gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A study was conducted of a current cohort of 108 consecutive cases of CM from 3 medical centers in Israel accrued during a 5-year period and 87 CM cases reported by the New England Trophoblastic Disease Center (NETDC) from the years 1988 to 1993. Clinical presentation and the rate of GTN of our cohort of CM and cases from the NETDC were compared. RESULTS: Fewer current CMs presented with vaginal bleeding than historic NETDC cases (52% vs. 84%, p < 0.001, respectively), and a greater proportion of current patients with CM were referred to termination of the pregnancy due solely to ultrasonographic findings (38% vs. 9%, p < 0.001, respectively). GTN rates were significantly lower in the current patients with CM compared to NETDC controls (14% vs. 23%,p<0.05, respectively). CONCLUSION: First-trimester ultrasound examination leads to early diagnosis of molar and of nonviable pregnancies subsequently histologically diagnosed as CM. The early evacuation of the molar pregnancy is associated with a reduction in the rate of GTN.