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B-HCG level when pregnant was 0000 and then increased to 304. /treated with methotrexate. How long to wait for another baby?

Mar 2016
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Dears ,,,

I am writing this message from Saudi Arabia , my wife was pregnant and before one month while she is having her second month follow up with her Dr , her Dr said that our baby is not growing and no fetal heart beat . my wife did D&C and before she do D&C her B-HCG were 0000 . after one week of D&C the B-HCG reduced to 0000 , the second week after the D&C the B-HCG increased to 0000 with increase of 304 the result of the following week of B-HCG showed that a decrease to 0000. Her Dr said as she had a partial vesicular more (hydatidiform mole) and there is no satisfied decrease of B-HCG , my wife will be treated with methotrexate. My question is , does she has to take methotrexate or if there is any change to wait and monitor the level of B-HCG ? and how much is the period that we have to wait to have other baby? your consultation is highly appreciated
Posted Thu, 1 Aug 2013 in Pregnancy
Answered by Dr. S Patra 2 hours later

Thanks for writing to us on Healthcare Magic.

First thing, partial vesicular mole (Hydatidiform mole) is one type of Gestational Trophoblastic Disease (GTD). It is commonly associated with high titer of serum beta-hCG for several weeks to months even after uterine evacuation by D & C.

The outcome of a partial hydatidiform mole after D & C is almost always benign and malignant potential is quite low. Persistent trophoblastic disease occurs in 1-4% and metastasis occurs only in 0.1% of cases. The risk of persistent or recurrent GTD is greatest in the first 12 months after uterine evacuation (mostly within 6 months).

In this scenario, chemotherapy with methotrexate is the best treatment option as there is high serum beta hCG for consecutive 3 weeks. She must continue it as per her doctor's recommendation.

At this stage, you have to follow some basic guidelines like:

1) Serum beta-hCG level should be monitored at 4 weeks interval till 6 months time duration or complete remission.

2) Next thing, pelvic examination is needed to carry out periodically by your gynecologist to check vulval or vaginal metastasis including size of uterus.

3) Chest X-ray is mandatory to detect lung metastasis. It should be done at 4 weeks interval till spontaneous remission and then at 3 months interval during follow-up.

4) Pelvic ultrasound is also essential to detect local or residual invasive tumor. It should be done at 4 weeks interval.

5) In the entire follow-up period, she would only use combined OCP and nothing else. It does not increase the incidence of postmolar GTD or alter the pattern of regression of beta-hCG values.

It is better to plan for next pregnancy after complete documented remission of the molar pregnancy for 6-12 months. You have to wait for at least 1 yr for next baby.

Hope, above information is quite helpful and easy understandable for you. If you have any other query, you can freely ask me.

Wish her good health and take care yourself.

Dr Soumen
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