Incidence and risk factors of post-molar gestational trophoblastic neoplasia: a prospective study


  • Shana Rahman K. P. Department of Obstetrics and Gynecology, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, Kerala, India
  • Sudhamani C. Department of Obstetrics and Gynecology, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, Kerala, India



Beta-hCG, Gestational trophoblastic disease, Gestational trophoblastic neoplasia, IMCH, Vesicular mole


Background: Gestational trophoblastic disease (GTD) is a group of disorders arising from abnormal trophoblastic cells. Gestational trophoblastic neoplasia (GTN) is a malignant counterpart of GTD. In the earlier era, morbidity and mortality associated with GTD was very high, 90-95% presenting with metastatic GTN in 1980’s.

Methods: This is a prospective study to analyze the incidence and to identify the risk factors of post-molar GTN and to evaluate the role of Beta-hCG level as a predictive factor of post-molar GTN, conducted in the department of Obstetrics and Gynecology, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, on patients attending the vesicular mole(VM) clinic. Group A (remission group - was diagnosed after 6 months of follow-up with undetectable Beta-hCG values) and Group B (post-molar GTN). The two groups were compared for identifying risk factors.

Results: There were 79 cases of molar pregnancy registered in VM clinic with an incidence of 4.87/1000 deliveries. Of the 79 patients with GTD, 17 were diagnosed to have GTN during follow-up with an incidence of 21.51% of GTD. Incidence of post-molar GTN were significantly more among patients with history of previous molar pregnancy. The median Beta-hCG level at 2 weeks post-evacuation and the ratio of Beta-hCG levels at 1week to 2 weeks post-evacuation was found to be highly predictive of post-molar GTN.

Conclusions: Incidence of GTD was higher compared to international studies. The ratio of post-evacuation Beta-hCG at 1 week to Beta-hCG at 2 weeks is the most reliable predictor of post-molar GTN.



Seckl MJ, Fisher RA, Salerno G, Rees H, Paradinas FJ, Foskett M, et al. Choriocarcinoma and partial hydatidiform moles. Lancet. 2000;356(9223):36-9.

Alvarado A, Candelaria M, Arce C. Gestational trophoblastic disease. Experience at National Institute of Cancerology. Ginecol Obstet México. 2005;73(06):308-14.

D’Couth S, Umadevi N, Pavithran M, Kalaam S, Nurul AA. A retrospective study of gestational trophoblastic neoplasia in a tertiary care centre. J Evol Med Dent Sci. 2013;2(31):5813-20.

Harma M, Yurtseven S, Gungen N. Gestational trophoblastic disease in Sanliurfa, southeast Anatolia, Turkey. Eur J Gynaecol Oncol. 2005;26(3):306-8.

Berkowitz RS, Goldstein DP. The management of molar pregnancy and gestational trophoblastic tumors. In: Knapp RC, Berkowitz RS, eds. Gynecologic Oncology. 2nd edn. New York: Mc Grow-Hill; 1993:328-338.

Nizam K, Haider G, Memon N, Haider A. Gestational trophoblastic disease: experience at Nawabshah Hospital. J Ayub Med Coll Abbottabad. 2009;21(1):94-7.

Berkowitz RS, Goldstein DP. In Berk JS Gestational trophoblastic neoplasm. Philadelphia, Lippincott, Williams and Wilkins; 2002:1353-74.

Mousavi AS, Karimi S, Modarres Gilani M, Akhavan S, Rezayof E. Does postevacuation β-human chorionic gonadotropin level predict the persistent gestational trophoblastic neoplasia? Int Schol Res Notices. 2014;2014.

Goldstein DP, Berkowitz RS, Bernstein MR. Management of molar pregnancy. J Reprod Med. 1981;26(4):208-12.

Ayhan A, Tuncer ZS, Halilzade H, Küçükali T. Predictors of persistent disease in women with complete hydatidiform mole. J Reprod Med. 1996;41(8):591-4.

Schlaerth JB, Morrow CP, Kletzky OA, Nalick RH, D’Ablaing GA. Prognostic characteristics of serum human chorionic gonadotropin titer regression following molar pregnancy. Obstet Gynecol. 1981;58(4):478-82.

Shigematsu T, Kamura T, Saito T, Kaku T, Nakano H, Kinugawa N. Identification of persistent trophoblastic diseases based on a human chorionic gonadotropin regression curve by means of a stepwise piecewise linear regression analysis after the evacuation of uneventful moles. Gynecol Oncol. 1998;71(3):376-80.

Kang WD, Choi HS, Kim SM. Prediction of persistent gestational trophobalstic neoplasia: the role of hCG level and ratio in 2 weeks after evacuation of complete mole. Gynecol Oncol. 2012;124(2):250-3.

Soares RR, Maestá I, Colón J, Braga A, Salazar A, Charry RC, et al. Complete molar pregnancy in adolescents from North and South America: clinical presentation and risk of gestational trophoblastic neoplasia. Gynecol Oncol. 2016;142(3):496-500.

John R, Lurain M. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol. 2010;9:531-9.

Chhabra S, Qureshi A. Gestational trophoblastic neoplasms with special reference to invasive mole. Obstet Gynecol India. 2007;57(2):124-7.

Ngan HY, Kohorn EI, Cole LA, Kurman RJ, Kim SJ, Lurain JR, et al. Trophoblastic disease. Int J Gynaecol Obstet. 2012;119(2):S130-6.

Eagles N, Sebire NJ, Short D, Savage PM, Seckl MJ, Fisher RA. Risk of recurrent molar pregnancies following complete and partial hydatidiform moles. Hum Reprod. 2015;30(9):2055-63.

Tse, Ka Yu, et al. Gestational trophoblastic disease. Obstetrics, Gynaecology & Reproductive Medicine 19.4 (2009): 89-97.

Berkowitz RS, Goldstein DP. Molar pregnancy. N Engl J Med. 2009;360(16):1639-45.

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(4):732-6.






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