Safety of different termination methods for hydatidiform mole coexisting with a normal fetus in the second trimester

Objective: To explore the safety of different termination methods of hydatidiform mole coexisting with a normal fetus in the second trimester of pregnancy. Design: A retrospective cohort study. Setting: A referral center for difficult and critical diseases in Obstetrics and Gynecology in China (Beijing). Population: Patients diagnosed hydatidiform mole coexisting with a normal fetus receiving termination of pregnancy in the second trimester (12 weeks to 27 +6 weeks). Methods: : Data were extracted and summarized on the complications of different termination methods. Chi square analysis was used to explore the association of factors and complications. Main outcome measures: Volume of blood loss and progression to gestational trophoblastic neoplasm. Results: : Different methods of terminating pregnancy in the second trimester of hydatidiform mole coexisting with a normal fetus were feasible, including forceps curettage, combination of mifepristone and misoprostol, intra-amniotic injection of rivanol, and cesarean section. The incidence of massive blood loss (over 300ml) was 50.0%. Molar tissues closer to the lower uterine segment than the fetus (P=0.035), and presence of complications (P=0.015) were the risk factors for massive blood loss during termination of pregnancy. The incidence of progression to gestational trophoblastic neoplasm was 35.7%. Conclusion: Different termination methods might lead to complications including massive blood loss and progression to gestational trophoblastic neoplasm. More medical measures should be taken to prevent and reduce the volume of bleeding among patients with high risk factors.