Gestational Trophoblastic Neoplasia Follow-up

Updated: Mar 05, 2015
  • Author: Enrique Hernandez, MD, FACOG, FACS; Chief Editor: Warner K Huh, MD  more...
  • Print
Follow-up

Further Outpatient Care

Patients with gestational trophoblastic neoplasia (GTN) should have follow-up serum hCG levels measured once per week until 4 normal values are obtained. Then, hCG levels should be obtained once per month for 1 year. Patients with stage IV disease are observed with monthly serum hCG level monitoring for 2 years after 3-4 consecutive weekly normal levels. Patients should use a reliable method of contraception.

Next:

Inpatient & Outpatient Medications

During the period of follow-up care, patients with GTN should use a reliable method of contraception, such as oral contraceptives or depot progesterone. The serum hCG levels are critical in monitoring the status of the disease, and a normal intrauterine pregnancy interferes with this critical monitoring tool.

Previous
Next:

Deterrence/Prevention

The early diagnosis of GTN by the close follow-up of serum hCG levels after the evacuation of a hydatidiform mole results in therapeutic intervention prior to the development of high-risk disease.

In patients with a history of gestational trophoblastic disease (GTD), measuring serum hCG levels 6 weeks after any subsequent pregnancy should be strongly considered to exclude occult GTN.

Previous
Next:

Patient Education

The pregnancy rate after chemotherapy with methotrexate and cyclophosphamide is 80%. Of women treated with EMA-CO, 46% have had at least 1 live birth after chemotherapy. [71, 72]

Patients who become pregnant after treatment for GTN should have pelvic ultrasonography early during the pregnancy to confirm that the pregnancy is normal.

A serum hCG level should be obtained 6 weeks after delivery of a subsequent pregnancy to exclude repeat GTN.

Previous