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 containing the word follow:
“The mother must teach her son how to respect and follow the rules. She must teach him how to compete successfully with the other boys. And she must teach him how to find a woman to take care of him and finish the job she began of training him how to live in a family. But no matter how good a job a woman does in teaching a boy how to be a man, he knows that she is not the real thing, and so he tends to exaggerate the differences between men and women that she embodies.”
—Frank Pittman (20th century)
“The banners flashing through the trees
Make their blood dance and chain their eyes;
That bugle-music on the breeze
Arrests them with a charm’d surprise.
Banner by turns and bugle woo:
Ye shy recluses, follow too!”
—Matthew Arnold (1822–1888)