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  • Title: An analysis of the influences of maternal age, gestational age, contraceptive method, and the mode of primary treatment of patients with hydatidiform moles on the incidence of subsequent chemotherapy.
    Author: Stone M, Bagshawe KD.
    Journal: Br J Obstet Gynaecol; 1979 Oct; 86(10):782-92. PubMed ID: 228696.
    Abstract:
    In relation to the total number of births in the United Kingdom there was an excess of hydatidiform moles arising in women over 34 years of age and possibly also under 15. The incidence of trophoblastic tumour requiring chemotherapy after hydatidiform mole was greatest in the 30 to 34 years age group and it was also high in the 20 to 24 years age group. This distribution appears to be influenced by the morphology of the moles, the mode of their removal and the use of oestrogens and progestogens in the post-evacuation period. The need for chemotherapy for trophoblastic tumour after evacuation of a hydatidiform mole was found to be two- to three-fold greater in patients who had undergone a medical induction, hysterectomy or hysterotomy compared with those whose hydatidiform moles had been evacuated by vacuum or surgical curettage, or who had aborted spontaneously. The increased risk of chemotherapy was most marked in the earlier weeks of gestation. 661 consecutive cases of diagnosed hydatidiform mole (HM) were studied at a London hospital, retrospectively, to determine the incidence of subsequent chemotherapy as influenced by maternal age, gestational age, contraceptive method, and mode of primary treatment (evacuation type). Of the 661 patients, 61 required chemotherapy. After medical induction, hysterotomy, or hysterectomy, chemotherapy was required in 19.8% compared with 6% for other methods (P .001) The chemotherapy group also tended to have evacuation or removal of HM at an earlier stage of gestation than patients not requiring chemotherapy. Incidence of chemotherapy was highest when the duration of gestation was 13-14 weeks and lowest after 20 weeks (P .05). In relation to the total number of births in the United Kingdom, there was an excess of HM arising in women over 34 years old and possibly under 15 years. Incidence of trophoblastic tumor requiring chemotherapy after HM was greatest in the 30-34 year age group, and it was also high in the 20-24 year group. This distribution was influenced by the morphology of HM, mode of removal, and the use of estrogens and progestogens in the postevacuation period. The need for chemotherapy for trophoblastic tumor after evacuation of HM was 2-3 fold greater in patients who had undergone a medical induction compared with those evacuated by vacuum or surgical curettage, or those had aborted spontaneously. The main limitation of the data is the absence of information on uterine size, and it is possible that uterine size influenced the method of primary treatment of the HM.
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