Simplifying the preevacuation testing strategy for patients with molar pregnancy.

Objective: To review our institution's preevacuation testing strategy for suspected molar pregnancy to determine whether a simplified approach might be indicated.

Study Design: Patients diagnosed with molar pregnancy from 1999 to 2004 were identified. Clinical data were retrospectively extracted from medical records.

Results: One hundred fifty-eight women diagnosed (mean age, 24 years) underwent dilatation and curettage. Molar pregnancy was suspected at presentation in 111 (70%); 47 (30%) cases were presumed miscarriages, and the diagnosis was confirmed only after histologic evaluation of the specimen. Initial testing included complete blood count (CBC) (87%), liver function tests (LFT) (63%), thyroid-stimulating hormone (TSH) level (72%), clotting function studies (26%) and chest radiograph (84%). One patient with right upper quadrant pain had elevated LFTs and a coagulopathy that resolved after evacuation. One woman with a palpably enlarged goiter and elevated TSH level was diagnosed with thyroid carcinoma. No chest radiograph demonstrated metastatic disease.

Conclusion: We advocate a simplified approach to preevacuation testing for suspected molar pregnancy that includes a CBC and blood type with antibody screen. Clinical assessment should prompt additional evaluation in the rare patient with suspicious signs and symptoms.