How many years of contraception after hydatidiform mole curettage

Pregnant mothers are very worried about the occurrence of hydatidiform mole and ectopic pregnancy, because both of them are abnormal pregnancies. Once discovered, the pregnancy must be terminated because the fetus is abnormal. Especially for hydatidiform mole, women need to use contraception for at least two years after undergoing a uterine curettage. Only after two years, if the HCG test results are normal, you can consider pregnancy.

Hydatidiform mole refers to the proliferation of trophoblastic cells of the placenta villi after pregnancy, severe edema of the interstitium, and the formation of blisters of varying sizes. The blisters are connected in clusters and shaped like grapes, also known as hydatidiform mole (HM). Hydatidiform mole is divided into two categories: ① Complete hydatidiform mole, in which all the placental villi are affected, the entire uterine cavity is filled with blisters, there is diffuse trophoblastic hyperplasia, and no fetal and embryonic tissues are visible; ② Partial hydatidiform mole, in which some placental villi are swollen and degenerated, there is local trophoblastic hyperplasia, and embryonic and fetal tissues are visible, but the fetus is mostly dead. Sometimes live fetuses younger than the gestational age or malformed fetuses can be seen, and full-term babies are rarely born.

Based on irregular vaginal bleeding after menopause, abnormal enlargement and softening of the uterus, the uterus is 5 months pregnant and the fetus cannot be felt, the fetal heartbeat cannot be heard, and there is no fetal movement, a hydatidiform mole should be suspected. Hyperemesis gravidarum, preeclampsia before 28 weeks of gestation, and bilateral adnexal cysts support the diagnosis. If vesicular tissue is seen in the vaginal discharge, the diagnosis of hydatidiform mole can be almost confirmed.

Once the diagnosis of hydatidiform mole is confirmed, it should be cleared immediately. When removing a hydatidiform mole, care should be taken to prevent excessive bleeding, uterine perforation and infection, and the chance of subsequent malignant transformation should be reduced as much as possible.

1. Clear the contents of the uterine cavity

Because the uterus of hydatidiform mole is large and soft, uterine perforation is prone to occur, so aspiration surgery is used instead of curettage. The advantages of aspiration uterus are quick operation and less bleeding. When suctioning the uterus, low negative pressure should be used and a large suction tube should be selected as much as possible to prevent uterine perforation and blockage by hydatidiform mole tissue that may affect the operation. If there are no conditions for suction uterus, curettage can still be performed.

2. Preventive chemotherapy

High-risk patients should receive preventive chemotherapy. High-risk factors include: ① age > 40 years old; ② abnormally high HCG value before the expulsion of hydatidiform mole; ③ obvious trophoblastic hyperplasia or atypical hyperplasia; ④ after the expulsion of hydatidiform mole, HCG does not decrease progressively, but after dropping to a certain level, it continues to stop decreasing or remains at a high value; ⑤ suspected metastatic lesions appear; ⑥ unconditional follow-up. Preventive chemotherapy generally uses only one drug, but the dosage of chemotherapy drugs should be the same as that used to treat cell tumors and the dosage cannot be reduced. Chemotherapy should be started 3 days before uterine curettage as much as possible and should be used for 1 to 2 courses.