Followup

♦ Regular HCG measurement

♦ Subsequent pregnancies increase risk of further molar pregnancy

♦ Rise in HCG means persistent gestational trophoblastic disease or invasive mole or choriocarcinoma has developed

If the HCG plateaus or starts to rise, this indicates that the patient has persisting molar disease or has developed an invasive mole (progression to choriocarcinoma and PSTT is rare). If a repeat ultrasound shows evidence of trophoblastic proliferation within the uterus, suction curettage may be performed. However, performing more than two D&Cs is not usually beneficial and will not prevent the subsequent need for chemotherapy. Uterine perforation is more likely if the HCG is >20 000 when a second D&C is contraindicated.

Other factors which increase the risk of needing subsequent chemotherapy include age >50 years and use of the oral contraceptive pill whilst HCG is still elevated. Accordingly, all patients are advised to use a barrier method of contraception following evacuation of a mole.

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