Postmolar contraception
Pandiyan, N.; Jequier, A.M.
Obstetrical and Gynecological Survey 43(5): 258-262
1988
ISSN/ISBN: 0029-7828 PMID: 3287245 DOI: 10.1097/00006254-198843050-00002Document Number: 371111
The practice of advising a women with hydatidiform mole to use contraception for 1-2 years before planning pregnancy is re-examined in the light of new information on etiology and cytogenetics of mole, risk of developing choriocarcinoma, as well as new technologies for following early pregnancy. The risk of choriocarcinoma after molar pregnancy has been reported at 1-15%, while the risk after all other types of pregnancy varies widely in the literature. Incidence of trophoblastic tumors varies much less in population-based estimates. It is unknown whether the risk of choriocarcinoma is the same for all 3 cytogenetic types of moles, homozygous complete XX, heterozygous complete XY or partial mole. It is likely that a defective ovum is the pathologic basis for mole and choriocarcinoma. The risk of subsequent malignancy is unrelated to the histologic appearance of the mole. The risk of habitual mole ranges from 1:50 to 1:150. As habitual moles recur, the risk of chorionic malignancy falls to extinction. Contraception does not affect the risk of choriocarcinoma: the reason why contraception was advised is that HCG levels due to normal pregnancy could not be distinguished from those due to mole before the advent of quantitative radioimmunoassay and ultrasound. Now normal pregnancy can be documented as early as 1 week after conception by radio receptor assay for HCG, combined with serial ultrasound.