Most molar pregnancies do not require treatment after the dilation and curettage. Complete molar pregnancies have a higher risk of developing into a malignancy, as do molar pregnancies in older women. Secondary treatment consists of chemotherapy. The exact chemotherapy regimen will be determined based on many criteria including:
- Pretreatment hCG level
- Age
- Time from prior pregnancy
- Number and sites of metastasis
- Failure of prior chemotherapy
Women with low-risk GTN may be successfully treated with single agent chemotherapy, most likely in the form of methotrexate or actinomycin-D. High-risk GTN is treated with multi-agent chemotherapy and requires overnight hospitalization during the administration. Women who do not wish to preserve their fertility may be treated with hysterectomy, but in high-risk disease, chemotherapy is still required. The hCG level will usually normalize after a few treatments. Chemotherapy will continue for 2 more cycles once normalization of hCG has occurred.
You will continue to have blood drawn to measures hCG levels each month for one year. Becoming pregnant is not recommended during the follow-up period since this can elevate hCG and make it difficult to determine whether an evelated hCG level is due to pregnancy or recurrence. Oral contraceptives are often used during the follow-up period to ensure infertility. There is no evidence that the use of chemotherapy in treating high risk GTN impacts future pregnancies or is associated with adverse fetal outcomes in subsequent pregnancies.
