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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Investigations:

  • full blood count - to exclude anaemia
  • platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen level - to exclude DIC
  • chest x-ray - to exclude trophoblastic emboli in lungs
  • electrocardiogram - if tachycardic or over 40 years

Immediately:

  • cross-match blood
  • arrange for an evacuation of the uterus under general anaesthesia

Initial treatment:

  • suction evacuation with sharp curettage of uterus; i.v. oxytocin to reduce blood loss
  • arrange for weekly monitoring of beta-hCG to detect recurrence - necessitates radioimmunoassay as titres may fall to a very low level
  • chemotherapy may be indicated if metastasis detected - usually methotrexate or actinomycin-D
  • there is rarely an indication for hysterectomy

Longer term management:

  • register with the tumour registry
  • monitor beta-hCG 2-4 weekly for the next 1-2 years
  • avoid pregnancy until beta-HCG levels have returned to normal for a period. Advice varies as to for what period of time normal levels should have been recorded before a further pregnancy. Some centres suggest 1-2 years of normal levels before pregnancy
  • avoid using the contraceptive pill until beta-hCG is undetectable as it delays tumour regression
  • advise patient that long term childbearing is not precluded

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