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Abstract
Introduction/Background The risk of Gestational Trophoblastic Neoplasia (GTN) following a partial molar pregnancy is very low. However, curettage remains the first line mode of evacuation since there is a lack in literature regarding medical evacuation. Therefore, we aimed to explore whether medical evacuation can be offered without increasing the risk of GTN and other complications as compared to suction curettage.
Methodology We conducted a retrospective cohort study including all prenatally diagnosed partial molar pregnancies (by ultrasound and DNA analysis either prenatal or postnatal) or postnatally diagnosed cases by DNA analysis after evacuation in Amsterdam UMC (location AMC and VUMC) from 2000 to 2023. We investigated the incidence of adverse outcomes between medical evacuation and curettage, defining adverse outcomes as GTN, maternal death, postpartum hemorrhage (mild >500ml and severe >1L) and incomplete removal leading to subsequent curettage.
Results We included 59 partial molar pregnancies, with 78% (46/59) diagnosed prenatally by ultrasound and DNA analysis (prenatal or postnatal) and 22% (13/59) diagnosed postnatally after evacuation. The median gestational age in prenatally detected cases was 12+6 (IQR, 11+5-15+4), with fetal anomalies on ultrasound as the primary reason for referral. Pregnancies were terminated in 42.4%, and 57.6% had intrauterine fetal demise, with medical evacuation used in 49.2% (n=29) and curettage in 50.8% (n=30). The median gestational age at evacuation was later in the medical evacuation group (15+0 versus 12+0, p<0.001). Adverse outcomes occurred in 30.5% (18/59), with 41.4% (n=12) after medical evacuation versus 20.0% (n=6) after curettage (p=0.09). Postpartum hemorrhage and incomplete removal occurred in 20.6% versus 13.3% (p=0.5) and 20.7% versus 6.7% (p=0.14), respectively. GTN and maternal death did not occur in any of the 59 cases.
Conclusion Medical evacuation does not lead to an increased risk of GTN compared to curettage. Patients pregnant with a partial molar pregnancy should be counseled on the different evacuation approaches (medical versus curettage). The pros and cons of both options should be discussed, including the chances of postpartum hemorrhage and incomplete removal with both options.
