Follow uo in a patient of H mole is done
Ans. is a i.e. Serum Beta HCG monitoring The chances of persistent trophoblastic disease and choriocarcinoma are high after evacuation of H.mole therefore regular follow up is mandatory. "After molar evacuation, patients should be monitored with weekly determinations of 0-subunit HCG levels until these levels are normal for 3 consecutive weeks, followed by monthly determinations until the levels are normal for 6 consecutive months. The average time to achieve the first normal HCG level after evacuation is about 9 weeks. At the completion of follow-up, pregnancy may be undeaken. After a patient achieves a nondetectable HCG level, the risk of developing tumour relapse is very low and may approach zero." Besides Serum Beta HCG at follow up following investigations are done : Pelvic examination -- To rule out any vulval and vaginal metastasis. -- To see the size of the uterus. -- To note the presence of any ovarian cysts and their sizes. It should be repeated every four weeks in the observation period. unest X-ray To detect lung metastasis Repeated at four weeks till spontaneous remission occurs and then at 3 months interval in the observation period. Pelvic Ultrasound : To detect any residual or locally invasive tumour and presence of ovarian cysts. Also Know : Patients are encouraged to use effective contraception during the entire interval of HCG follow up (i.e. atleast for 1 year). Choice of contraception : IUCD : should not be used because of the potential risk of uterine perforation and IUCDs cause irregular uterine bleeding which can be confused with persistent trophoblastic disease. Progestin pills : cause irregular bleeding therefore should not be used. OCP's : Earlier it was believed that OCP's should not be used till HCG values return to normal. But now it is said - "OCP's may be used safely after molar evacuation during the entire interval of hormonal follow up". "Oral contraceptives are found to be superior to Barrier method or use of IUCD in decreasing the risk of developing gestational trophoblastic neoplasia". Barrier method : Earlier they were the contraception of choice in case of GTDs. (Now it is combined pills).
Serum Beta-HCG monitoring
Serum CEA level estimation
Serum amylase level
Serum a feto protein estimation