Usually, any type of gestational trophoblastic disease can be successfully diagnosed and treated, without endangering reproductive function.
A molar pregnancy (hydatidiform mole) or any type of gestational trophoblastic neoplasia is completely removed, usually by D and C with suction. Removal of the uterus (hysterectomy) is rarely necessary but may be done if women do not plan to have children.
Tests are done to determine whether women need additional treatment after the mole is removed.
A chest x-ray is taken to see whether the molar pregnancy tissue has spread to the lungs.
The level of human chorionic gonadotropin in the blood is measured to determine whether the molar pregnancy was completely removed. When removal is complete, the level returns to normal, usually within 10 weeks, and remains normal, and no further treatment is needed. While hCG is being measured, women should use effective contraception because pregnancy makes interpreting hCG measurement difficult. If the level does not return to normal, the disease is considered persistent. Then, computed tomography (CT) of the brain, chest, abdomen, and pelvis is done to determine whether choriocarcinoma has developed and spread.
Chemotherapy is needed if the molar pregnancy tissue persists or has spread. If the molar pregnancy is considered low risk, chemotherapy may consist of only one chemotherapy drug. If this treatment is ineffective, a combination of chemotherapy drugs may be used, or hysterectomy may be done.
If the molar pregnancy tissue has spread widely and is considered high risk, doctors refer women to a specialist.
After a hysterectomy, if done, chemotherapy is given and hCG levels are monitored to make sure the disease has been successfully treated.
When gestational trophoblastic disease is diagnosed, doctors talk to women about their desire to be able to have children. If chemotherapy, which may damage the ovaries, is needed, sometimes steps can be taken to preserve fertility, such as freezing eggs before chemotherapy is given. Even if hysterectomy is done, the ovaries do not need to be removed to treat molar pregnancy.
Women who have had a molar pregnancy removed are advised not to become pregnant for 12 months. Oral contraceptives are frequently recommended, but other effective contraceptive methods can be used. Pregnancy is delayed so that doctors can make sure that treatment was successful.
If women who have had a molar pregnancy become pregnant, doctors do ultrasonography early in the pregnancy to determine whether the pregnancy is normal. After the baby is delivered, doctors usually send the placenta to a laboratory to be checked for abnormalities.
