Diagnosis and Management of Hydatidiform Mole in Pregnancy

Initial Diagnostic Approach

Vaginal bleeding is the most common presenting symptom, typically occurring between 6-16 weeks of gestation, according to the National Comprehensive Cancer Network 3, 4
The American College of Obstetricians and Gynecologists recommends ultrasound examination as the primary imaging modality for initial diagnosis, with uterine artery Doppler as an optional adjunct 1, 2
Serum hCG measurement is typically elevated beyond the expected level for gestational age, and it is important to use an assay that can detect all forms of beta hCG, as recommended by the European Society for Medical Oncology 1, 2, 5, 6

Blood group determination is required for potential anti-D immunization in Rh-negative women, as recommended by the American College of Obstetricians and Gynecologists 1
Chest X-ray is recommended if clinical suspicion of metastases or as baseline, according to the National Comprehensive Cancer Network 1
Thyroid function tests should be performed if hyperthyroidism is suspected, as recommended by the Endocrine Society 1, 2

Suction curettage under anesthesia is the standard procedure for both diagnosis and treatment, with blood available pre-operatively due to risk of significant blood loss, as recommended by the American College of Obstetricians and Gynecologists 1, 2, 7
Histologic examination is the definitive method for diagnosis and classification, differentiating between complete hydatidiform mole and partial hydatidiform mole, according to the College of American Pathologists 7

Ultrasound or hysteroscopy should be performed to ensure complete evacuation, as recommended by the American College of Obstetricians and Gynecologists 1
Reference pathology review in a Gestational Trophoblastic Disease center within 2 weeks is considered best practice, according to the Society of Gynecologic Oncology 1, 8

Serum hCG monitoring at least once every 2 weeks until normalization is recommended, with use of hCG assay type as advised by the Gestational Trophoblastic Disease center, according to the National Comprehensive Cancer Network 1, 8
For complete hydatidiform mole, monthly hCG for up to 6 months after normalization is recommended, as advised by the European Society for Medical Oncology 8
For partial hydatidiform mole, one more normal serum hCG over 1 month after initial normalization is recommended, according to the American College of Obstetricians and Gynecologists 8