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Hydatidiform Mole Management
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Suction curettage + β-hCG surveillance until undetectable.
Decision
Outcome
Decision
Hydatidiform mole diagnosed. First step?
✓
Suction curettage
✗
Methotrexate
Decision
After curettage — surveillance?
✓
Weekly β-hCG until undetectable, then monthly for 6 months; contraception during surveillance
Decision
β-hCG trend?
✓
Decreasing to undetectable → continue monthly surveillance × 6 mo
✓
Increasing or plateauing → gestational trophoblastic neoplasia
Outcome
Surveillance complete; safe to attempt pregnancy after 6 months undetectable
Outcome
Refer to gynecologic oncology — methotrexate (low risk) or multi-agent chemotherapy (high risk)
Complete mole: 46,XX (paternal). Partial mole: 69,XXY triploid.