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
Complications related to treatment