Following molar evacuation, a patient with complete hydatidiform mole shows the following beta-hCG pattern: Day 0 = 80,000, Day 14 = 10,000, Day 28 = 8,200, Day 42 = 7,900. According to FIGO 2000 criteria, this pattern indicates gestational trophoblastic neoplasia (GTN). Which FIGO criterion is met?
- A Four values showing rise over 3 weeks (1, 7, 14, 21 days) — 10% or more rise
- B A plateau (less than 10% change) of four weekly beta-hCG values over 3 weeks (21 days) ✓
- C Beta-hCG above 20,000 mIU/mL more than 4 weeks after evacuation
- D Any detectable beta-hCG at 8 weeks after molar evacuation
Correct answer: B. A plateau (less than 10% change) of four weekly beta-hCG values over 3 weeks (21 days)
Explanation
FIGO 2000 criteria for diagnosing GTN after molar evacuation include: (1) beta-hCG plateau (±10% of previous value) for 4 measurements over ≥3 weeks; (2) rise ≥10% over 3 consecutive measurements over ≥2 weeks; (3) histologic diagnosis of choriocarcinoma; (4) persistently elevated hCG 6 months after evacuation. In this patient, Day 28 (8200) and Day 42 (7900) show plateau — combined with the prior two measurements (Day 14, Day 28), this constitutes a 4-value plateau over 21+ days, meeting criterion 1. This requires further investigation and treatment as GTN.
Reference: Williams Obstetrics, 26th ed.
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