Hydatidiform mole: clinical analysis of 310 patients

The aim of the study was to analyze the clinical characteristics, treatment and outcome of 310 patients with hydatidiform mole.

Three hundred ten patients with hydatidiform mole admitted to Dr Zekai Tahir Burak Women's Hospital between 1989 and 1994, were evaluated retrospectively according to their clinical characteristics, treatment modalities and follow-up.

The incidence of molar pregnancy was 2.48 per 1000 deliveries and 1.84 per 1000 pregnancies. The age of the patients ranged from 14 to 45 years with a mean age of 25.29 +/- 7.40 years. In 60% of the patients, the molar pregnancy was their first pregnancy. A history of previous hydatidiform mole was found in 5.5% of the patients and eight of them had at least two previous molar pregnancies. The most common presenting symptom was vaginal bleeding (71%). Although theca-lutein cysts were found in 17.1% of the patients, only one patient underwent emergency surgery because of torsion. Dilatation and suction curettage was the first-line treatment; uterine perforation developed in two patients (0.6%). During follow-up 14.5% of patients were diagnosed as persistent cases according to serum beta-human chorionic gonadotropin (beta-hCG) levels. Complete remission was achieved with the administration of 2-8 courses of single-agent chemotherapy in 43 cases; combined chemotherapy (3-7 courses) was given to two patients who were resistant to single-agent therapy.

Comparison of patients with spontaneous remission and patients with persistent trophoblastic disease with respect to age, histologic type, previous history, initial uterine size, gravidity, presence of theca-lutein cysts and initial beta-hCG levels did not reveal any of the above criteria to be prognostic for the occurrence of persistent disease.