Gestational Trophoblastic Disease · Evacuation vs Chemotherapy vs Hysterectomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Molar vs GTN + risk stratification + fertility
   Molar pregnancy or GTN? FIGO/WHO score? Completed childbearing?
   • Molar pregnancy (complete/partial) → Molar → suction evacuation
   • GTN, FIGO/WHO low-risk (score ≤6) → GTN low-risk → single-agent chemotherapy
   • GTN, high-risk (score ≥7)/widespread metastasis → GTN high-risk → EMA-CO
   • Completed childbearing/control bleeding/chemo-resistant confined to uterus / placental site trophoblastic tumor (PSTT) → Completed childbearing/resistant/PSTT → hysterectomy
2. [End] Molar → suction evacuation
   Molar pregnancy → suction evacuation (ultrasound-guided); anti-D immunoglobulin if Rh-negative; serial hCG monitoring postoperatively to normal; rising/plateauing hCG or metastasis → manage as GTN.
3. [End] GTN low-risk → single-agent chemotherapy
   GTN low-risk (FIGO/WHO score ≤6) → single-agent chemotherapy (methotrexate or actinomycin D); resistance → switch to the other single agent or to combination; consolidate after hCG normalizes.
4. [End] GTN high-risk → EMA-CO
   GTN high-risk (score ≥7)/widespread metastasis → multi-agent combination chemotherapy (EMA-CO) ± local treatment (radiotherapy/surgery for brain/liver metastases); treat at a specialist center.
5. [End] Completed childbearing/resistant/PSTT → hysterectomy
   Completed childbearing, control bleeding, chemo-resistant disease confined to the uterus, or placental site trophoblastic tumor (PSTT, chemo-insensitive) → hysterectomy (PSTT is primarily surgical).

Source guidelines & references

• Gestational trophoblastic disease management (FIGO staging and WHO prognostic score; NCCN)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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