PRIOR cesarean delivery was linked to higher postmolar gestational trophoblastic neoplasia risk, without increased chemoresistance overall.
Cesarean Delivery and Postmolar Gestational Trophoblastic Neoplasia Risk
A retrospective cohort study across two gestational trophoblastic disease reference centers examined whether a prior cesarean delivery history influenced the likelihood of developing postmolar gestational trophoblastic neoplasia after a hydatidiform mole. Investigators reviewed records of patients with histopathologically confirmed hydatidiform mole from January 2002 to December 2022 and compared outcomes in those with versus without previous cesarean delivery.
Among 2,904 patients, prior cesarean delivery was independently associated with a higher risk of postmolar gestational trophoblastic neoplasia. After adjustment for clinically relevant factors, including age, complete hydatidiform mole histology, pre-evacuation human chorionic gonadotropin level, location of uterine evacuation, year of diagnosis, and other covariates, the association remained significant. In adjusted modeling, a history of cesarean delivery corresponded to an estimated 45% increase in odds of postmolar gestational trophoblastic neoplasia.
The analysis also explored whether risk varied by cesarean delivery characteristics. Neither the number of prior cesarean deliveries nor an elective indication appeared to meaningfully modify the association, suggesting the observed risk signal was not confined to one subgroup of patients with prior cesarean delivery history.
No Clear Signal for Greater Chemoresistance
To assess clinical aggressiveness, the study evaluated resistance to single-agent chemotherapy among 621 patients with low-risk gestational trophoblastic neoplasia. Prior cesarean delivery history was not significantly associated with chemoresistance in this subgroup. Similarly, neither the number of prior cesarean deliveries nor the indication for prior cesarean delivery demonstrated a significant relationship with resistance outcomes.
What This Means for Postmolar Surveillance
These findings support continued use of current management protocols while reinforcing the importance of careful postmolar surveillance. The authors suggest that patients with prior cesarean delivery, also termed caesarean section, may warrant heightened clinical vigilance within standard follow-up pathways, given the elevated risk of postmolar gestational trophoblastic neoplasia without evidence of increased treatment resistance.
Reference: Paiva G et al. Tracking the Cesarean Delivery-Postmolar Gestational Trophoblastic Neoplasia Link. Obstet Gynecol. 2026;doi:10.1097/AOG.0000000000006196.
