Indication of methotrexate in molar pregnancy:
Indications for chemotherapy in GTD histological evidence of choriocarcinoma Evidence of metastasis in brain ,liver,GIT,or radiological opacities >2 cm on chest x-ray Pulmanory ,vulval or vaginal metastases unless serum beta hcg is falling Heavy vaginal bleeding or evidence of gastrointestinal or intraperitoneal haemorrhage Rising serum beta HCG values after evacuation Serum beta hCG >20,000 IU/L more than 4 weeks after evacuation because of the risk of uterine perforation (refer pgno:172 sheila textbook of obstetrics 2 nd edition)
Fetal hea activity present
Theca lutein cysts size <4cm
P-hCG 4000 MlU\/ml
Evidence of metastasis
General obstetrics