management
Last reviewed 01/2018
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