Changes in diagnostic sensitivity, incidence and presentation of complete and partial hydatidiform mole over the years

Objective: Molar pregnancy is the most common type of gestational trophoblastic disease. Several recent reports have described changes in the clinical representation, the incidence and the diagnostic sensitivity of molar pregnancy. These changes could be due to widespread use of transvaginal ultrasound and beta-hCG testing in the management of routine first-trimester investigations. Study design: This is a retrospective study of 144 women diagnosed with partial or complete mole at a regional medical center during 2007–2020. Incidence, demographics, clinical features and diagnostic sensitivity were compared between 2007 and 2014 and 2015–2020, and attempts were made to understand the bases of the changes between the time periods. Results: Sixty-two moles were diagnosed during 2007–2014 and 82 during 2015–2020. The proportions of complete moles in the respective periods were 65% (40) and 18% (15). From the earlier to the later period, the incidence and proportion of complete moles decreased, and of partial moles, increased. The median gestational age at diagnosis of molar pregnancy was 9.3 weeks. In the later period, women presented less frequently with vaginal bleeding, though this remained the most common presenting symptom. The proportion of women who underwent surgical evacuation of the uterus due to suspected molar pregnancy decreased, as did the proportion of moles that was suspected in ultrasound evaluation (P < 0.001). Conclusion: The proportion of complete moles decreased between the periods examined. Gestational age at diagnosis was similar to data from 1994 to 2013. Some typical presenting symptoms of molar pregnancy decreased. However, earlier diagnosis of missed abortion can miss diagnoses of molar pregnancy.