A 42-year-old woman undergoes suction evacuation for a complete hydatidiform mole. She lives in a remote area with unreliable follow-up. Her β-hCG is 200,000 mIU/mL and the uterus is 24 weeks in size. Which of the following is the most appropriate preventive measure to reduce the risk of post-molar gestational trophoblastic neoplasia?
- A Weekly methotrexate for 8 weeks
- B Prophylactic total abdominal hysterectomy
- C Single-dose actinomycin-D at evacuation ✓
- D Serial β-hCG monitoring every 2 weeks
Correct answer: C. Single-dose actinomycin-D at evacuation
Explanation
Prophylactic chemotherapy at the time of evacuation is considered for high-risk complete mole patients with poor follow-up to prevent GTN. Hysterectomy reduces risk but is not the standard preventive measure for fertility preservation. Serial β-hCG is standard follow-up, not prevention.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.