Answer: It is important that you are followed up after a molar pregnancy as these cells can remain in the uterus and potentially grow and spread. For your follow-up after a molar pregnancy it will be necessary for you to have regular blood tests to monitor the level of hCG in your blood. This is because molar tissue produces hCG. In Ireland we have established a National Centre for the monitoring of women diagnosed with molar pregnancy. This centre is called the National Gestational Trophoblastic Disease Registry, Monitoring and Advisory Centre and is located in Cork University Maternity Hospital under the leadership of Dr John Coulter.
Following diagnosis of a complete molar pregnancy (CHM) your hCG blood levels will be monitored on a weekly basis until the levels have returned to normal. This blood test can be performed at your local hospital or by your GP depending on your preference. Each result will be communicated to the National Gestational Trophoblastic Disease Registry, Monitoring and Advisory Centre at Cork University Maternity Hospital (CUMH) and you will be advised of the result of the test. In the vast majority of patients (85%) the hCG levels return to normal usually within 8 to 12 weeks. Following a normal result for 3 weeks in a row you will then have a blood test on a monthly basis for up to 6 months as there is a small risk that the cells can re-grow (recur). If all of these monthly results are normal, then your follow up will be complete and you will be discharged from the service.
In approximately 15% of patients the hCG levels will not return to normal, thereby signifying persistence of the complete molar cells. In these patients some chemotherapy treatment will be required to eliminate these cells. In the majority of cases (>95%) this chemotherapy treatment is successful in eliminating these cells.
Partial Molar pregnancy (PHM)
Following a diagnosis of a partial molar pregnancy your hCG blood levels will need to be monitored on a weekly basis until the levels have returned to normal. Once normal, only one further confirmatory blood test is required 4 weeks later. This blood test can be performed at your local hospital or by your GP depending on your preference. Each result will be communicated to the National Gestational Trophoblastic Disease Registry, Monitoring and Advisory Centre CUMH and you will be advised of the result and your progress. In approximately 98% of patients with a partial mole, the hCG levels will spontaneously drop to normal and no further treatment will be required, signifying that the molar pregnancy has resolved.
However, in 1-2% of patients the hCG levels do not return to normal and some chemotherapy treatment is necessary. In the majority of cases (>95%) this treatment is successful in eliminating these cells.
Becoming Pregnant Again
The majority of women with GTD who wish to will become pregnant again and have successful pregnancies. The risk of a further molar pregnancy is low. More than 98% of women who become pregnant following a molar pregnancy will not have a further hydatidiform mole and are not at increased risk of complications.
Risk of a repeat GTD
The risk of a repeat GTD is approximately 1 in 100, compared with approximately 1 in 600 risk in the general population.