A review of the referral pathway for molar pregnancy in NUH

Nesma Salem, Hannah Bruguier, Annabelle Harris, Nahida Ijaz, Sophie Kennedy, Valentina Rumyantseva, Sajjida Ajjawi

Objective

The aim of our project was to establish the timeline from histological diagnosis to referral to a regional trophoblastic disease centre at Nottingham University Hospitals NHS Trust.

Design

Retrospective clinical audit.

Method

This is a retrospective study of 86 cases investigated for molar pregnancy from August 2023 to August 2024. Patients included had both ultrasound and histology performed for suspected molar pregnancy. Molar pregnancy was confirmed by histology in 23 cases. Two cases were omitted in statistical analysis due to missing data.

Results

The age range was 18-52 years old. The time between histological result to referral ranged from 0 to 79 days with a mean of 17 days. 52% of referrals were achieved within 14 days. 46% of the patients were referred between 15 and 31 days and the remaining 1% were referred after 1 month. 

Conclusions

The delay between histology results and referral varies significantly, with only 52% of cases being referred within 14 days. Given the potential for molar pregnancy to progress into invasive disease or choriocarcinoma, prompt referral to trophoblastic centre is crucial for patient safety. The implementation of a more structured referral system, such as the 'two-week-wait' policy, may be essential.