Recommendations
SOGC/GOC Clinical Guideline #408, January 2021
It is recommended that hCG be tested in women of childbearing potential who present with abnormal uterine bleeding, bleeding > 6 weeks post-pregnancy, or evidence of metastatic disease to rapidly diagnose and manage gestational trophoblastic disease ( high, low).
Anatomopathological examination of any product of conception that appears abnormal at the time of curettage and aspiration should be performed to exclude GTD (strong, very low).
The initial assessment for post-molar GTNs should include a chest X-ray to detect any pulmonary metastasis as well as a pelvic ultrasound to assess the extent of the pelvic involvement (strong, moderate).
Initial workup for suspected CC, GTN after non-molar pregnancy, and/or post-molar GTN with lung metastases on chest X-ray should include pelvic ultrasound, chest and abdominal computed tomography (with hepatic arterial phase), and MRI imaging (strong, medium).
If a hydatidiform mole is suspected, women should be offered either vacuum evacuation or hysterectomy as an initial management strategy (strong, moderate).
After uterine evacuation, it is recommended to offer anti-D immunoglobulin to all Rh-negative women to prevent alloimmunization (strong, high).
Weekly monitoring with quantitative serum hCG should be initiated 2 weeks after evacuation of all molar pregnancies and continued until the level remains undetectable for 3 consecutive weeks. In case of CHM, it is recommended to continue monitoring monthly for 6 months. In case of PHM, it is recommended to measure hCG 1 month after the first result of undetectable level in order to confirm the resolution (strong, high).
Women are recommended to use a reliable method of contraception for the duration of follow-up after a molar pregnancy (strong, medium).
In the event of a history of GTN or recurrent molar pregnancy, follow-up of a subsequent pregnancy should include early ultrasound, detailed examination of the placenta and pathological examination of any non-viable pregnancy (strong , high).
If GTN is diagnosed, prompt referral to a gynecological oncology specialist for staging, risk score, and treatment (strong, high) is recommended.
Women with low-risk GTN should receive monochemotherapy, although hysterectomy is an option for some patients (strong, high).
It is recommended that women with high-risk GTN receive combination chemotherapy at a center specializing in the management of this disease (strong, high).
There is a need for women with ultra-high-risk GTN with liver or brain metastases or with a score of ≥ 13, to receive, in a center specializing in the management of this disease, preferably in a reference center , low-dose induction chemotherapy with etoposide and cisplatin weekly for 1 to 3 weeks to prevent complications of uncontrolled bleeding, followed by combination chemotherapy (strong, high).
In the event of pregnancy during the follow-up of a GTD or a GTN, the woman should be referred to gynecological oncology and maternal-fetal medicine for evaluation and management (strong, very low ).
It is recommended to carry out the management of women with GTD in a specialized center and to record their data in a centralized register (regional and/or national), when possible (strong, high).
2021. Guideline No. 408: Management of Gestational Trophoblastic Diseases. Eiriksson L, Dean E, Sebastianelli A, Salvador S, Comeau R, Jang JH, Bouchard-Fortier G, Osborne R, Sauthier Ph. J Obstet Gynaecol Can;43(1):91-105.
Modified on 12/22/2023