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Follow-up after treatment of gestational trophoblastic disease

After mole evacuation

  • Serum hCG is monitored every other week until <1 IE/L for three repeated measurements. Serum hCG is then checked monthly for 6 months.
  • Birth control is recommended during the entire follow-up period after hcg is normalized (<1IE/L). Options include birth control pills, IUD or barrier method, or sterilization.

After chemotherapy for gestational trophoblastic disease

Serum hCG is checked:

  • before start of each course
  • weekly the first 3 months after treatment
  • every other week from 3-6 months after treatment
  • monthly from 6-12 months after treatment

Low risk patients do not need follow-up after one year. It is recommended the patient should use effective birth control for one year until after the first normal hCG (<1IE/L) measurement.

High risk patients have hCG testing as described above for 12 months, thereafter every 3 months for an additional 12 months. The patient is recommended to use effective birth control for 24 months after the first normal measurement of hCG.

Patients with placental-site trophoblastic tumors have hCG testing as described above for the first 2 years, then every 6 months for 5-10 years. Thereafter, the patient will have annual follow-up for life due to the risk for late recurrence. 

Pregnancy after gestational trophoblastic disease

Patients with normal hCG 8 weeks after evacuation are discouraged from becoming pregnant during the first 6 months. 

Patients with raised hCG 8 weeks after evacuation are discouraged from becoming pregnant during the first 12 months.

Pregnancy during the follow-up period often has a normal outcome. It is important the patient has follow-up with repeated hCG testing and early ultrasound to exclude a possible new molar pregnancy. New trophoblastic disease at the next pregnancy is rare, but may occur. For pregnancy after trophoblastic disease, a vaginal ultrasound should be performed early in the pregnancy. After the birth, the placental should be carefully inspected and sent for a histological examination.

Complications related to the disease:

  • Tumor bleeding
  • Uterine bleeding
  • Brain hemorrhaging
  • Hemoptysis

Complications related to treatment

  • Uterine perforation during evacuation/biopsy.

  • Respiratory insufficiency at the start of treatment in a patient with visible lung metastases.
  • Brain hemorrhage at the start of treatment of brain metastases.
  • Kidney, liver, and neurotoxicity from methotrexate.
  • Consider listing toxicities associated with EMA-CO. 

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