Complete hydatidiform mole - A disease with a changing profile

OBJECTIVE: Tb retrospectively evaluate the clinical presentation of complet e molar pregnancies in an academic primary obstetrics and gynecology practi ce over the past decade. STUDY DESIGN: All cases of abnormal pregnancy presenting to our institution during the first half of gestation were identified through a computerized database. Clinical presentation and course of complete moles were analyzed. RESULTS: Twenty-four complete molar pregnancies were identified among 2,431 abnormal Parry gestations (1%). The patients' mean age was 24.5 years, and the mean gestational age was 9.5 weeks of amenorrhea (range, 8-25). Sevent y-five percent of the patients presented with vaginal bleeding and 54% with excessive uterine size. None had hyperemesis gravidarum, preeclampsia, cli nical hyperthyroidism or ovarian enlargement. All patients had abnormally e levated serum beta-hCG. Transvaginal ultrasound was diagnostic in more then half the patients, while it was suggestive of the diagnosis in the remaind er. One patient experienced postevacuation trophoblastic embolization and d eveloped persistent gestational trophoblastic disease. CONCLUSION: Due to the routine use of transvaginal ultrasound and serum bet a-hCG in the workup of early gestational abnormalities, complete molar preg nancy rarely presents today with the traditional signs and symptoms. Despit e their absence, the potential for persistent trophoblastic disease still e xists, and careful follow-up is warranted.