Information for clinicians

Guidelines

New updated guidelines effective from 1st July 2023

Data analysis of over 17,000 women diagnosed with a Complete Hydatidiform Mole in the UK shows that:

• If the hCG level normalises within 56 days from the date of evacuation, with a follow up confirmatory normal blood hCG 4 weeks later, the detection rate of persistent disease is extremely low.

Therefore, for women diagnosed with a complete mole with hCG normalisation within 56 days of the date of the evacuation, the national gestational screening service has deemed it is safe to no longer require hCG monitoring for a 6 month period.

• These women can be discharged once their blood and a confirmatory hCG level is normal.

• They can try again for a new pregnancy.

For those women with a complete mole who take more than 56 days for their hCG to fall to normal after the date of evacuation, the original 6 months of further normal hCG monitoring remains in place at present.

New update effective from 1 December 2020

In keeping with practice throughout the UK we will be reviewing all histology cases, we request the relevant paraffin blocks and slides are sent:
FAO Katie McDonald, Department of Histopathology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF

PLEASE CONTINUE TO REGISTER ALL PTS FOR F/UP FOLLOWING A MOLAR PREGNANCY

New guidelines for post pregnancy screening of hCG effective from 1st July 2017

Data analysis of more than 13,000 GTD patients in the UK shows that:

• The detection rate for recurrent GTD on routine post-pregnancy screening of women previously diagnosed with one molar pregnancy is extremely low.

• For women previously treated with GTN post pregnancy monitoring should still be continued.

Therefore:

The national gestational screening service has deemed it safe to no longer require hCG monitoring for women post pregnancy who have had one previous molar pregnancy that has not required chemotherapy.

Guidelines for oral contraceptives - effective from 1 January 2014

• Oestrogen and progestogens taken between evacuation of the mole and the return to normality of hCG values appear not to increase the risk of invasive mole or choriocarcinoma developing.

• Therefore women may use oral contraceptives after molar evacuation, before the hCG returns to normal. 

Patient registration

Patient registration for tumour marker monitoring of hydatidiform moles is now available online. UK gynaecologists registering women with one of the specialist centres (Dundee, London or Sheffield) for this disease should use the NHSnet online form. This website provides a secure system complying with DH standards and the Data Protection Act 1998.

To register a new patient via NHS net.

Note: this site is external to the Sheffield Trophoblastic Disease Centre. If you have any problems please email icthelpdesk@imperial.nhs.uk If you are still having problems ring: +44 203 311 5555.

If you are unable to register online you can copy, complete and email the electronic version (Google Docs, 21KB or download the form in Word 27.5KB) to sht-tr.trophoblastic@nhs.net 

Contact information for the other UK Centres. 

A guide to management practices at Weston Park Hospital

The booklet Gestational trophoblastic neoplasia: a guide to management at Weston Park Hospital (PDF, 388KB) provides a guide for all clinicians concerned with the management of patients with Gestational Trophoblastic Disease (GTD) at Weston Park Hospital (WPH), Sheffield Teaching Hospitals NHS Trust (STHFT). This booklet was revised December 2022.

Patients will receive a copy of Gestational trophoblastic disease: information for patients (PDF, 376KB).

International Society for the Study of Trophoblastic Diseases (ISSTD)

An online edition of the book Gestational Trophoblastic Disease (3rd edition) is available on the International Society for the Study of Trophoblastic Diseases (ISSTD) website.

European Organisation for Treatment of Trophoblastic Disease (EOTTD)

The EOTTD is a European network for clinicians and researchers working in the field of GTD.

The Placental Site Trophoblastic Tumour Database

This is an international research project using an online database to gather data about this rare medical condition. The project relaunched in 2017 collecting data about Ultra high risk gestational trophoblastic neoplasia along with previously unreported PSTT cases. Registration is necessary.

Educational modules from National GTD Study day 8th March 2023

The UK GTD service held a national study day in Sheffield on 8th March 2023. Presentations from the day were recorded and can be viewed here. For further educational purposes, we have included some assessment questions at the end of some of the talks.