MOLAR PREGNANCY: FOLLOW-UP BEYOND ONE UNDETECTABLE SERUM β-hCG, IS IT NECESSARY? Nirmala CK, Harry SR, Nor Azlin MI, Lim PS, Shafiee MN, Nur Azurah AG, Shamsul AS, Omar MH, Hatta MD Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur. Malaysia. Gestational trophoblastic disease is a common gynaecological problem in Asia with incidence of 1 to 3 in 1000 pregnancies 2-7. In Malaysia, the estimated incidence of molar pregnancy was 2.8 in 1000 deliveries in GTD is considered highly curable, but accurate initial management is essential. GTD produces serum β-hCG level (human chorionic gonadotropin), which can be measured in either urine or serum and will be extremely high in molar pregnancy. After molar evacuation, patients should be followed with serum β-hCG level monitoring and are considered to have achieved remission when serum β-hCG level decline to undetectable level within six months. In view of possible theoretical risk of relapse or developing persistent gestational trophoblastic disease (pGTD), the patients are recommended for continued follow-up with serum β-hCG level for a period of two years. Women often defaulted follow-up and do not complete the recommended long protocol. The long protocol has caused significant practical and emotional complications to the woman and her family. Gestational trophoblastic disease is a common gynaecological problem in Asia with incidence of 1 to 3 in 1000 pregnancies 2-7. In Malaysia, the estimated incidence of molar pregnancy was 2.8 in 1000 deliveries in GTD is considered highly curable, but accurate initial management is essential. GTD produces serum β-hCG level (human chorionic gonadotropin), which can be measured in either urine or serum and will be extremely high in molar pregnancy. After molar evacuation, patients should be followed with serum β-hCG level monitoring and are considered to have achieved remission when serum β-hCG level decline to undetectable level within six months. In view of possible theoretical risk of relapse or developing persistent gestational trophoblastic disease (pGTD), the patients are recommended for continued follow-up with serum β-hCG level for a period of two years. Women often defaulted follow-up and do not complete the recommended long protocol. The long protocol has caused significant practical and emotional complications to the woman and her family. INTRODUCTION OBJECTIVES To determine the need to continue follow-up for uncomplicated molar pregnancy beyond attaining one undetectable serum β-hCG level. The number of defaulters and the number of patient who relapsed after achieving one undetectable serum β-hCG level were determined. This study will help to evaluate our hospital protocol for follow-up of patients with molar pregnancy with an aim to change our future surveillance policy to ensure an optimal care. METHODOLOGY AND RESULTS Between January 2005 and December 2010, 102 patients were diagnosed to have molar pregnancy. The incidence of hydatidiform mole was 2.6 per 1000 deliveries in our centre. The mean age of patients with molar pregnancy were 31.98±7.86 years with minimum age 17 years old and maximum age 55 years old. Majority of the patient were multiparous (69.6 %) Mean gestational weeks at presentation was 10.71±3.43 weeks. The most advanced gestational week at the time of diagnosis was at 24 weeks. 60 patients (58.8%) had normal antecedent pregnancy. Only one patient had a previous complete hydatidiform molar pregnancy. Presenting clinical features n=102 (%) Vaginal bleeding97 (95.1) Hyperemesis4 (3.9) Symptom of thyrotoxicosis1 (1) Clinical diagnosis miscarriage31 (30.4) Hypertension4 (3.9) Sign of thyrotoxicosis1 (1.0) Uterus larger than dates18 (17.6) Ultrasound ‘snow-storm’ feature48 (47.1) Presenting initial diagnosis Molar pregnancy70 (68.6) Miscarriage32 (31.4) RESULTS Histology diagnosisn=102 (%) Complete hydatidiform mole47 (46.1) Partial hydatidiform mole57 (53.9) Mean pre-evacuation serum β-hCG level (mIU/ml) p=0.47  Complete hydatidiform mole ±  Partial hydatidiform mole ± Mean post-evacuation serum β-hCG level (mIU/ml) p=0.45  Complete hydatidiform mole ±  Partial hydatidiform mole ± The number of patients who developed persistent trophoblastic disease before attaining one undetectable serum β-hCG level was 4 (3.9%). The number of patient with uncomplicated molar pregnancy was 98 out of 102 patients (96.07%). 28 out of 102 (27.5%) of the patients defaulted follow-up before completion of protocol. 15 out of 28 (53.5 %) had get pregnant before completed follow up and the rest 13 out of 28 (46.4%) were loss follow up. There was no patient who appeared to have relapsed following one undetectable serum β-hCG level in uncomplicated molar pregnancy. DISCUSSION This study recommended that patient with uncomplicated molar pregnancy to have a shorter duration of follow up not exceeding six months after one undetectable serum β- hCG level. This provided minimal additional benefit while increasing financial and emotional burden to patient and maybe one of the contributing factors for defaulting follow-up. The limitation of this study was being a retrospective study, thus, all measurement and the result reflect the situation in UKMMC at that particular time. 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