A 22 years old female underwent suction evacuation for molar pregnancy. Beta HCG levels are persistently high following evacuation. The next line of management is:
**Core Concept**
Beta HCG levels persistently high after evacuation of a molar pregnancy indicate a possible persistent gestational trophoblastic disease (GTD), which can progress to a more malignant form known as gestational trophoblastic neoplasia (GTN). The management of persistent GTD/GTN requires a multidisciplinary approach and often involves medical and/or surgical interventions.
**Why the Correct Answer is Right**
In cases of persistent GTD/GTN, the next line of management typically involves the administration of systemic chemotherapy to control the disease. Methotrexate is a commonly used chemotherapeutic agent in the management of GTD/GTN, particularly in cases with low-risk disease. It works by inhibiting the dihydrofolate reductase (DHFR) enzyme, which is essential for DNA synthesis and cell division. This leads to the death of rapidly proliferating trophoblastic cells.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect as it does not address the need for systemic treatment in cases of persistent GTD/GTN.
**Option B:** This option is incorrect as it does not specify the use of a chemotherapeutic agent, which is the next line of management in these cases.
**Option C:** This option is incorrect as it does not address the need for systemic treatment in cases of persistent GTD/GTN.
**Clinical Pearl / High-Yield Fact**
Remember that GTD/GTN can be a life-threatening condition if left untreated, and prompt initiation of systemic chemotherapy is crucial in controlling the disease. Methotrexate is a commonly used chemotherapeutic agent in low-risk cases, but higher-risk disease may require more aggressive treatment regimens.
**Correct Answer:** C. Methotrexate