Using the FIGO/WHO prognostic scoring system for gestational trophoblastic neoplasia (GTN), a patient scores: age 30 (0), antecedent hydatidiform mole (0), interval from index pregnancy 6 months (1), pre-treatment βhCG 12,000 IU/L (2), largest tumour 3 cm (1), single lung metastasis (1), no prior chemotherapy (0). What is the total score and the recommended treatment?

• A Score 5 — high risk; multi-agent EMA-CO
• B Score 7 — high risk; EMA-CO
• C Score 4 — low risk; single-agent methotrexate
• D Score 5 — low risk (≤6); single-agent methotrexate or actinomycin-D ✓

Explanation

FIGO/WHO scoring: age (0) + antecedent mole (0) + interval 4–6 months (1) + βhCG 10,000–100,000 IU/L (2) + largest tumour 3–4 cm (1) + single lung metastasis (1) + no prior chemotherapy (0) = total 5. A score of 0–6 defines low-risk GTN, treated with single-agent chemotherapy — methotrexate (with folinic acid rescue) or actinomycin-D if methotrexate is contraindicated or resistant. Multi-agent EMA-CO is reserved for high-risk disease (score ≥7).

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.