A patient with complete hydatidiform mole undergoes suction evacuation. Post-evacuation, her β-hCG falls from 85,000 IU/L to 420 IU/L over 8 weeks but then rises to 960 IU/L on week 10. CT thorax shows two 1.5 cm pulmonary nodules. WHO score is 4. The MOST appropriate treatment is:

• A Single-agent methotrexate with folinic acid rescue ✓
• B EMA-CO combination chemotherapy
• C Surgical resection of pulmonary nodules followed by chemotherapy
• D Repeat uterine curettage before initiating chemotherapy

Explanation

A WHO/FIGO prognostic score of ≤6 defines low-risk GTN, which is treated with single-agent chemotherapy — either methotrexate (with folinic acid) or actinomycin-D. EMA-CO is used for high-risk GTN (WHO score ≥7). This patient scores: 4 (antecedent mole) + 0 (interval <4 months is ambiguous but β-hCG rise within 10 weeks) — full scoring on all 8 factors is needed, but score of 4 places her in low-risk category. Pulmonary metastases in GTN respond excellently to chemotherapy; surgical resection is not required upfront.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.