Oncovin (vincristine). In selected cases, adjuvant surgical and radiotherapy may also be employed (Hanna, 2010). Frequent causes of death include hemorrhage from metastatic sites, respiratory failure, sepsis, and multiorgan failure due to widespread chemoresistant disease (Lybol, 2012; Neubauer, 2015).
With either low-or high-risk disease, once serum �-hCG levels are undetectable, serosurveillance is continued for 1 year. During this time, efective contraception is crucial to avoid any teratogenic efects of chemotherapy to the fetus and to mitigate conusion from rising �-hCG levels caused by superimposed pregnany (Secki, 2010; Williams, 2014). For those who conceive despite this within the surveillance year following treatment, pregnancy may continue since most will have a favorable outcome (Tse, 2012; Woolas, 1998). Importantly, this group is advised of the low but important risk of delayed diagnosis if tumor recurs during the pregnancy (Blagden, 2002; Tuncer, 1999b).
A small number of women during surveillance, despite no evidence of metastases, will be found to have very low �-hCG levels that plateau. This phenomenon is called quiescent hCG and presumably is caused by dormant trophoblast. Close observation without therapy is recommended, but 20 percent will eventually have recurrent active and progressive trophoblastic neoplasia (Ngu, 2014).
Women with prior hydatidiform mole generally do not have impaired fertility, and their pregnancy outcomes are usually normal Qoneborg, 2014; Matsui, 2011; Sebire, 2003). One concern is the 2-percent risk for developing trophoblastic disease in a subsequent pregnancy, which was described earlier. Sonographic evaluation is recommended in early pregnancy, and subsequently if indicated.
Women who have successfully completed GTN chemotherapy are advised to delay pregnancy for 12 months. Fertility and pregnancy outcomes are typically normal, and congenital anomaly rates are not increased (Berkowitz, 2000; Tse, 2012). One exception is an unexplained higher stillbirth rate of 1.5 percent compared with a background rate of 0.8 percent (Vargas, 2014).
After hydatidiform mole or GTN treatment, in subsequent pregnancy, the placenta or products of conception are sent for pathological evaluation at delivery. A serum 3-hCG level is measured 6 weeks postpartum (Lurain, 2010).
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