A 26-year-old woman is diagnosed with a complete hydatidiform mole. Following suction evacuation β-hCG is 18,000 IU/L. Six weeks later β-hCG has fallen to 4,200 IU/L, continuing to fall by 30% per week. What is the recommended follow-up action?

• A Initiate chemotherapy for persistent GTN
• B Repeat uterine evacuation to reduce hCG load
• C Perform chest X-ray and start prophylactic actinomycin D
• D Continue surveillance with weekly β-hCG until undetectable, then monthly for 6 months from normalisation ✓

Explanation

A continuously falling β-hCG after molar evacuation indicates spontaneous regression and does not require chemotherapy. RCOG guidelines recommend weekly β-hCG monitoring until undetectable, then monthly follow-up for 6 months from normalisation if the complete mole resolves promptly (or 12 months if it takes more than 56 days to normalise). Repeat evacuation is not recommended. Prophylactic chemotherapy is not indicated.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.