This study aimed to evaluate the operative safety, efficiency, and oncologic outcomes of a standardized misoprostol-assisted surgical evacuation protocol for molar pregnancies.

We conducted a single-center retrospective cohort study of 118 patients with histologically confirmed hydatidiform moles. All patients received 400 μg of vaginal misoprostol for cervical ripening 3–4 h before undergoing ultrasound-guided suction curettage. The primary outcomes included operative metrics (need for mechanical dilation, blood loss, operative time) and the incidence of post-molar gestational trophoblastic neoplasia (GTN). Beta-human chorionic gonadotropin (β-hCG) normalization and reproductive outcomes were also analyzed.

The protocol demonstrated high operative efficiency. Cannula passage was achieved without mechanical dilators in 94.9% of patients, with a mean operative time of 15.2 min. No major complications (uterine perforation, cervical laceration, or trophoblastic embolism) occurred. Blood transfusion was required in 4.2% of cases. The overall post-molar GTN incidence was 13.6%, which is consistent with established literature; the rate for complete moles was 20.3%, with no cases following partial moles. Among patients desiring future pregnancy, the live birth rate was 81.5%.

The use of misoprostol for cervical ripening before surgical evacuation of molar pregnancy is safe and effective. It facilitates a controlled procedure with favorable operative outcomes and does not appear to increase the risk of GTN.