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Molar Pregnancy: Epidemiology, Diagnosis, Management, Surveillance

  • Family Planning (A Roe and S Sonalkar, Section Editors)
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Abstract

Purpose of Review

This review describes recommendations for the diagnosis and management of molar pregnancy, with focus on emerging evidence in recent years, particularly as it pertains to nuances of diagnosis, risk stratification, and surveillance of post-molar malignant trophoblastic disease.

Recent Findings

Topics discussed include advances in histopathologic diagnosis of molar pregnancy to standardize analysis, most recent estimations of post-molar pregnancy malignancy, and updated surveillance guidelines.

Summary

Hydatidiform molar pregnancy, resulting from an abnormal fertilization event, is the proliferation of abnormal pregnancy tissue with malignant potential. With increased availability of first trimester ultrasound, early detection of molar pregnancy has increased. While challenging to diagnose radiologically and histologically at early stages, standardization of tissue analysis allows improved detection and increased accuracy of incidence estimate for both complete and partial molar pregnancy. Treatment of molar pregnancy requires evacuation of tissue. Prophylactic chemotherapy or repeat curettage have been explored but not favored. As new molecular markers are sought, our ability to predict malignant transformation following molar pregnancies will allow for more streamlined surveillance. Recent data support a reduction in the length of surveillance following normalization of human chorionic gonadotropin levels after evacuation.

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    Authors and Affiliations

    1. Department of Obstetrics & Gynecology, Duke University, Durham, NC, USA

      Alice J. Darling

    2. Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Duke University, Durham, NC, USA

      Benjamin B. Albright & Brittany A. Davidson

    3. Department of Pathology, Duke University, Durham, NC, USA

      Kyle C. Strickland

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    AD: Project design, literature review, manuscript draft, critical revision, final approval. BA: Project conception and design, literature review, critical revision, final approval. KS: Collecting and preparing specimens for manuscript figure, critical revision, final approval. BD: Project conception and design, literature review, critical revision, final approval.

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    Darling, A.J., Albright, B.B., Strickland, K.C. et al. Molar Pregnancy: Epidemiology, Diagnosis, Management, Surveillance. Curr Obstet Gynecol Rep 11, 133–141 (2022). https://doi.org/10.1007/s13669-022-00327-6

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