After successful treatment of a hydatidiform mole, hCG surveillance shows a plateau at 280 IU/L over 3 consecutive weekly measurements (weeks 6, 7, 8 post-evacuation). Chest X-ray is clear. What is the most appropriate next step?
- A Repeat uterine evacuation
- B Commence single-agent chemotherapy (methotrexate) ✓
- C Wait for two more weeks before treating
- D Hysterectomy as definitive treatment
Correct answer: B. Commence single-agent chemotherapy (methotrexate)
Explanation
A plateau in hCG (defined as four values over 3 weeks, or three values over 2 weeks showing <10% change) meets criteria for gestational trophoblastic neoplasia (GTN) requiring treatment per FIGO/RCOG guidelines. Low-risk GTN (as assessed by FIGO/WHO scoring — <7 on the 2000 WHO prognostic score) is treated with single-agent methotrexate or actinomycin-D. Repeat uterine evacuation risks uterine perforation and does not replace chemotherapy. Hysterectomy is an option only in selected cases.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.