Hydatidiform mole and medical management of miscarriage

doi:10.1136/bmj.332.7555.1454

BMJ 2006;332:1454 (17 June), doi:10.1136/bmj.332.7555.1454

Letter

Hydatidiform mole and medical management of miscarriage

The first 150 words of the full text of this article appear below.

EDITOR—Trinder et al suggest that expectant managementmay be particularly appropriate for cases of incomplete miscarriageand as an alternative management in early fetal death.¹ Onepossible cause of first trimester miscarriage is hydatidiformmolar pregnancy, which is associated with a significantly increasedrisk of subsequent development of persistent gestational trophoblasticdisease.

Only around 40% of hydatidiform moles are detected as molaron pre-evacuation ultrasound examination, most appearing tobe incomplete or missed miscarriages by sonography alone.² Furthermore,after termination of pregnancy patients presenting with symptomaticpersistent gestational trophoblastic disease, compared withthose who have the diagnosis made histologically after evacuation,are significantly more likely to experience life threateningcomplications and to require additional surgical or chemotherapeuticinterventions.³

Routine histopathological examination of evacuated productsof conception after failure of early pregnancy remains the goldstandard for detecting molar pregnancy. The proportion of casesin whom tissue is submitted . . . [Full text of this article]

Neil J Sebire, consultant in trophoblastic disease pathology

Trophoblastic Disease Unit, Charing Cross Hospital, London WC1N 3JH sebirn@gosh.nhs.uk

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