A 30-year-old woman undergoes uterine evacuation for a complete hydatidiform mole. Post-evacuation hCG levels are monitored. According to FIGO 2000 criteria for gestational trophoblastic neoplasia (GTN), which of the following ALONE constitutes an indication to initiate chemotherapy?
- A hCG plateau (< 10% change) over 3 weekly measurements for 2 weeks
- B hCG plateau (< 10% rise or fall) over 4 measurements across 3 weeks ✓
- C hCG rise ≥ 10% for 2 consecutive weekly measurements
- D hCG still detectable at 6 weeks post-evacuation
Correct answer: B. hCG plateau (< 10% rise or fall) over 4 measurements across 3 weeks
Explanation
FIGO 2000 criteria for diagnosis of post-molar GTN (requiring chemotherapy) include: (1) hCG plateau (defined as < 10% rise or fall across 4 values over ≥ 3 weeks); (2) hCG rise ≥ 10% across 3 values over ≥ 2 weeks; (3) hCG still detectable at 6 months post-evacuation; (4) histological diagnosis of choriocarcinoma; or (5) presence of metastases. A plateau of 4 measurements over 3 weeks (option B) is the correct definition. Option A incorrectly states 3 measurements over 2 weeks without the < 10% rise specification. Option C requires 3 consecutive values (not 2) for a rise criterion.
Reference: Williams Obstetrics, 26th ed.
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