Management

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