A 28-year-old woman presents 8 weeks after a molar evacuation with a serum beta-hCG of 2400 mIU/mL (plateau for 3 consecutive weeks). CT scan shows no metastases. WHO/FIGO prognostic scoring is performed. Age 28 = 0 points; antecedent pregnancy = hydatidiform mole = 0 points; interval from index pregnancy = 4 months = 1 point; pre-treatment hCG = 2400 = 1 point; largest tumor size = 3 cm = 1 point; site of metastases = none = 0 points; number of metastases = 0 = 0 points; prior failed chemotherapy = none = 0 points. Total score = 3. Management is:

• A Multi-agent chemotherapy (EMA-CO)
• B Single-agent chemotherapy (methotrexate or actinomycin-D) ✓
• C Hysterectomy as primary treatment
• D Repeat uterine evacuation and await hCG normalisation

Explanation

WHO/FIGO score ≤6 = low-risk GTN, treated with single-agent chemotherapy (methotrexate with folinic acid rescue or actinomycin-D). Score ≥7 = high-risk GTN requiring multi-agent EMA-CO. This patient scores 3 (interval 4 months = 1 point; hCG 2400 = 1 point; tumor 3 cm = 1 point; all other parameters = 0), placing her in the low-risk category. Note: GTN interval scoring — <4 months = 0, 4–6 months = 1, 7–12 months = 2, >12 months = 4. With a score of 3, single-agent chemotherapy is appropriate.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.