A 24-year-old woman is diagnosed with a complete hydatidiform mole at 14 weeks gestation. Pre-evacuation serum β-hCG is 250,000 mIU/mL. She has a uterus size corresponding to 20 weeks and bilateral theca lutein cysts measuring 8 cm each. After suction evacuation, which of the following is the most appropriate management regarding the theca lutein cysts?
- A Surgical removal (cystectomy) to prevent torsion
- B Aspiration under ultrasound guidance
- C Expectant management; they will regress spontaneously ✓
- D Ovarian suppression with GnRH agonists
Correct answer: C. Expectant management; they will regress spontaneously
Explanation
Theca lutein cysts associated with molar pregnancy are caused by high β-hCG levels stimulating the ovaries. After evacuation, as β-hCG levels decline, the cysts regress spontaneously over 2-4 months. Surgical intervention is reserved for complications such as torsion or rupture. Aspiration is rarely needed. Prophylactic surgery or medical suppression is not indicated. The key is to monitor and allow natural regression as the hormonal stimulus resolves.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.