Follow Up
Follow up is necessary in all women with gestational trophoblastic disease, because of the possibility of persistent disease, or because of the risk of developing malignant uterine invasion or malignant metastatic disease even after treatment in some women with certain risk factors.
The use of a reliable contraception method is very important during the entire follow up period, because the follow-up depends on measuring hCG. If a reliable contraception method is not used during the follow-up, there can be great confusion if hCG rises: Why did it rise? Because the patient became pregnant again? Or because the gestational trophoblastic disease is still present? Therefore, during the prescribed follow up period, the patients must not become pregnant.
In women who have a malignant form of GTD, hCG concentrations stay the same (plateau) or they rise. Persistent elevation of serum hCG levels after a non molar pregnancy (i.e., normal pregnancy, or preterm pregnancy, or ectopic pregnancy, or abortion) always indicate persistent GTD (very frequently due to choriocarcinoma or placental site trophoblastic tumour), but this is not common, because treatment mostly is successful.
In rare cases, a previous GTD may be reactivated after a subsequent pregnancy, even after several years. Therefore, the hCG tests should be performed also after any subsequent pregnancy in all women who had had a previous GTD (6 and 10 weeks after the end of any subsequent pregnancy).
Read more about this topic: Gestational Trophoblastic Disease
Famous quotes related to follow up:
“The General Order is always to manoeuver in a body and on the attack; to maintain strict but not pettifogging discipline; to keep the troops constantly at the ready; to employ the utmost vigilance on sentry go; to use the bayonet on every possible occasion; and to follow up the enemy remorselessly until he is utterly destroyed.”
—Lazare Carnot (1753–1823)