Algorithm for the Management of Molar Pregnancy - Flowchart
Algorithm for the Management of Molar Pregnancy - Flowchart Molar Pregnancy Molar Pregnancy
«Flowchart»

Molar pregnancy

Molar pregnancy

Molar pregnancy


Chest x-ray (CXR)
Pelvic/abdominal ultrasound to assess for thecal lutein cysts
T3/T4 if pulse >100 or signs or symptoms of thyrotoxicosis
CBC, differential, platelets, PT, PTT
Type and screen (give RhoGam if Rh negative and no antibodies)
Arterial blood gases if CXR is abnormal or respiratory compromise is suspected, patient is hypertensive, or uterus is greater than 16–18-wk size


Chest x-ray (CXR)
Pelvic/abdominal ultrasound to assess for thecal lutein cysts
T3/T4 if pulse >100 or signs or symptoms of thyrotoxicosis
CBC, differential, platelets, PT, PTT
Type and screen (give RhoGam if Rh negative and no antibodies)
Arterial blood gases if CXR is abnormal or respiratory compromise is suspected, patient is hypertensive, or uterus is greater than 16–18-wk size


Chest x-ray (CXR)
Pelvic/abdominal ultrasound to assess for thecal lutein cysts
T3/T4 if pulse >100 or signs or symptoms of thyrotoxicosis
CBC, differential, platelets, PT, PTT
Type and screen (give RhoGam if Rh negative and no antibodies)
Arterial blood gases if CXR is abnormal or respiratory compromise is suspected, patient is hypertensive, or uterus is greater than 16–18-wk size


Chest x-ray (CXR)
Pelvic/abdominal ultrasound to assess for thecal lutein cysts
T3/T4 if pulse >100 or signs or symptoms of thyrotoxicosis 3 4
CBC, differential, platelets, PT, PTT
Type and screen (give RhoGam if Rh negative and no antibodies)
Arterial blood gases if CXR is abnormal or respiratory compromise is suspected, patient is hypertensive, or uterus is greater than 16–18-wk size

Evacuate or hysterectomy

Evacuate or hysterectomy

Evacuate or hysterectomy

Staging


Baseline
CT abdomen and pelvis
CT brain

Staging


Baseline
CT abdomen and pelvis
CT brain

Staging


Baseline
CT abdomen and pelvis
CT brain


Baseline
CT abdomen and pelvis
CT brain

Postevacuation CXR

Postevacuation CXR

Postevacuation CXR

Weekly serum hCG contraception

Weekly serum hCG contraception

Weekly serum

Metastases

Metastases

Metastases

Monthly titers × 6 then every 2-3 mo for 6 mo

Monthly titers × 6 then every 2-3 mo for 6 mo

Monthly titers × 6 then every 2-3 mo for 6 mo

For subsequent pregnancy confirm absence of H. mole by early ultrasound

For subsequent pregnancy confirm absence of H. mole by early ultrasound

For subsequent pregnancy confirm absence of H. mole by early ultrasound

Postpartum, repeat hCG at 6 wk

Postpartum, repeat hCG at 6 wk

Postpartum, repeat hCG at 6 wk

End

End

End

Metastases

Metastases

Metastases

No metastases

No metastases

No metastases

Staging


Baseline
CT abdomen and pelvis
CT brain

Staging


Baseline
CT abdomen and pelvis
CT brain


Baseline
CT abdomen and pelvis
CT brain Staging

hCG surveillance

hCG surveillance

hCG surveillance

or

or

or

Single-agent chemotherapy

Single-agent chemotherapy

Single-agent

Hysterectomy

Hysterectomy

Hysterectomy

Risk according to WHO prognostic scoring and treat accordingly

Risk according to WHO prognostic scoring and treat accordingly

Risk according to WHO prognostic scoring and treat accordingly

Remission: Steady decline of hCG to normal for 3 values

Remission: Steady decline of hCG to normal for 3 values

Remission

Titer plateau × 3 wk
Titer rise (rule out new occult pregnancy)

Titer plateau × 3 wk
Titer rise (rule out new occult pregnancy)


Titer plateau