Follow-up after molar pregnancy evacuation: Feasibility of using semi-quantitative urine pregnancy tests

OBJECTIVE: To evaluate human chorionic gonadotropin (hCG) trends after evacuation of complete hydatidiform moles to determine if urinary semiquantitative pregnancy tests (SQPTs) could replace blood draws while still detecting early postmolar gestational trophoblastic neoplasia. STUDY DESIGN: A retrospective review of complete hydatidiform moles at a safety-net hospital from 2003-2013 was performed. hCG curves were used to extrapolate expected SQPT results over time for a resolving hydatidiform mole. RESULTS: Of 61 complete moles, 37 had an uncomplicated hCG decline and at least 4 serum hCG results. All of those patients had hCG <10,000 mIU/mL within 15 days, <2,000 within 64 days, <500 within 70 days (92.2% within 1 month), <100 within 89 days (90% within 2 months), and <25 within 152 days (95.2% within 3 months). After reaching levels <25, hCG rose only in cases of new pregnancies. CONCLUSION: Based on this retrospective analysis, SQPT monitoring could have avoided 90% of blood draws while still flagging all patients with subsequent postmolar GTN within 45 days by limiting blood draws to (1) patients with SQPT levels of >10,000, >500, and >100 mIU/mL at 15, 30, and 45 days, respectively, (2) hCG >25 after 60 days, or (3) increasing SQPT levels.