Gestational trophoblastic disease: is intensive follow up essential in all women?

Objective: To determine the timescale of the registration process for gestational trophoblastic disease and its impact on hCG level at registration and subsequent need for chemotherapy.

Design: A prospective observational study using a standardised protocol for registration, assessment and treatment for molar pregnancy.

Setting: A supra-regional tertiary referral centre for gestational trophoblastic disease.

Participants: A total of 2046 consecutive women registered between January 1994 and December 1998 with a diagnosis of molar pregnancy.

Methods: Data at and after registration, collected prospectively on a computerised database, were statistically analysed (by multiple logistic regression and ANOVA).

Main Outcome Measures: Relationship between length of time to and hCG value at registration; also the subsequent need for chemotherapy.

Results: A total of 2046 women with a diagnosis of molar pregnancy were registered in the study period. The mean time interval between first evacuation and registration at the referral centre was 47 days (median 37, range 0-594). One hundred and five out of 2046 (5.1%) women needed chemotherapy. Sixty-three precent of the women (1296 out of 2046) had a normal level of urinary hCG (less than 40 IU/24 hours) at the time of registration and only one (0.08%) needed chemotherapy. Binary logistic regression analysis showed a statistically significant relationship between time to registration, hCG value, histology, pretreatment risk score and decision to administer chemotherapy.

Conclusion: Women with gestational trophoblastic disease who were registered late were significantly more likely to have normal levels of hCG and were less likely to need chemotherapy. A less intensive follow up may be justified in women with gestational trophoblastic disease who are registered with a normal hCG level.