Simplifying the preevacuation testing strategy for patients with molar pregnancy

Area of Science:

• Gynecology
• Obstetrics
• Reproductive Medicine

Background:

• Molar pregnancy diagnosis often requires histologic evaluation after initial presentation as miscarriage.
• Current preevacuation testing protocols may be overly extensive for suspected molar pregnancy.

Purpose of the Study:

• To evaluate the effectiveness of the institution's preevacuation testing strategy for molar pregnancy.
• To determine if a simplified testing approach is warranted.

Main Methods:

• Retrospective review of clinical data for 158 women diagnosed with molar pregnancy between 1999 and 2004.
• Analysis of initial laboratory and imaging tests performed prior to surgical evacuation.

Main Results:

• Molar pregnancy was initially suspected in 70% of cases; 30% were initially presumed miscarriages.
• Common preevacuation tests included complete blood count (CBC), liver function tests (LFT), thyroid-stimulating hormone (TSH), and chest radiograph.
• One patient with elevated LFTs and coagulopathy improved post-evacuation.
• One patient with elevated TSH was diagnosed with thyroid carcinoma; no metastatic disease was found on chest radiograph.

Conclusions:

• A simplified preevacuation testing strategy for suspected molar pregnancy is proposed.
• Recommended tests include CBC and blood type with antibody screen.
• Additional testing should be based on clinical presentation and patient-specific signs and symptoms.