{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T19:16:09Z","timestamp":1785352569424,"version":"3.55.0"},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,1,15]],"date-time":"2016-01-15T00:00:00Z","timestamp":1452816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the outcome of women with persistently raised but falling human chorionic gonadotrophin (<jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content>) levels 6 months after surgical evacuation of a molar pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>An 11\u2010year retrospective review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The United Kingdom supra\u2010regional trophoblastic disease treatment centres at Weston Park Hospital (Sheffield) and Charing Cross Hospital (London).<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women with raised but falling serum human chorionic gonadotrophin (<jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content>) levels 6 months after evacuation of a molar pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective case note review of eligible women identified by the electronic databases held at each supra\u2010regional centre.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>The proportion of women that attain normal <jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content> levels spontaneously without chemotherapy. In addition, rates of gestational trophoblastic neoplasia (<jats:styled-content style=\"fixed-case\">GTN<\/jats:styled-content>), drug resistance, disease relapse and overall survival are reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010five women with molar pregnancy and raised but falling serum <jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content> levels continued surveillance 6 months after evacuation. Levels of <jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content> in 30 of the patients (86%) fell to normal levels spontaneously. One woman defaulted follow up prior to <jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content> normalisation (3%) and the remaining four women (11%) were treated with chemotherapy due to a plateau or rise in serum <jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content> levels indicating <jats:styled-content style=\"fixed-case\">GTN<\/jats:styled-content>. All treated women were successfully salvaged by either first (<jats:italic>n<\/jats:italic> = 1) or second line (<jats:italic>n<\/jats:italic> = 2) chemotherapy or found to have persistently raised low level <jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content> of uncertain clinical relevance (<jats:italic>n<\/jats:italic> = 1). No women developed relapsed disease and overall survival was 100%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Women with a molar pregnancy and a raised but falling <jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content> level beyond 6 months from uterine evacuation can be safely observed with regular <jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content> monitoring and can usually avoid potentially toxic chemotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Women with treated molar pregnancy may avoid chemotherapy if 6\u2010month <jats:styled-content style=\"fixed-case\">hCG<\/jats:styled-content> levels are raised but 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