Treatment

♦ Gentle suction curettage

♦ Spontaneous abortion

♦ Hysterotomy, caesarean section increases the risks two-fold of chemotherapy required to eradicate persistent trophoblastic disease

The information from the staging investigations is used in the scoring system to determine the risk of developing drug resistance to methotrexate. Patients who score <5 will be cured with methotrexate alone in at least 75% of cases, while only 30% are cured who score 5-8. Nevertheless, the latter patients are also offered methotrexate therapy to start with since this treatment carries no risk of long-term sequelae. Methotrexate may cause bleeding through rapid involution of metastases. Patients scoring >9 receive 'high-risk' intravenous combination chemotherapy comprising etoposide, methotrexate, and actinomycin D (EMA), alternating weekly with cyclophosphamide and vincristine (CO). Treatment with either methotrexate or EMA/CO regimens continues until the HCG has been normal for six weeks.

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