A 26-year-old woman who underwent suction evacuation of a complete hydatidiform mole 10 weeks ago has serial serum beta-hCG measurements showing a plateau over three consecutive weeks. Chest radiograph shows two small nodular opacities in the right lung field. Uterine size is normal and there is no vaginal bleeding. What is the most appropriate next step in management?

• A Repeat suction evacuation of the uterus
• B Repeat beta-hCG after another 4 weeks before any intervention
• C Total hysterectomy with bilateral salpingo-oophorectomy
• D Start single-agent chemotherapy and register for FIGO scoring ✓

Explanation

A plateaued beta-hCG over three consecutive weeks after molar evacuation meets the diagnostic criterion for gestational trophoblastic neoplasia, and the presence of lung metastases confirms non-metastatic versus low-risk metastatic disease depending on FIGO score, both treated primarily with single-agent chemotherapy such as methotrexate or actinomycin B. Repeat evacuation does not address metastatic trophoblast, and hysterectomy removes the uterus without treating disseminated disease, so delaying treatment risks progression of a highly chemosensitive tumour.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.