## **Core Concept**
A molar pregnancy, also known as hydatidiform mole, is a type of gestational trophoblastic disease (GTD) characterized by abnormal proliferation of trophoblastic tissue and the formation of hydropic villi. The management of molar pregnancy depends on the patient's age, desire for future fertility, and the presence of any complications. Uterine size larger than dates can be due to molar pregnancy, among other causes.

## **Why the Correct Answer is Right**
The correct answer, **D. Suction evacuation**, is the treatment of choice for molar pregnancy, especially in a woman with a significantly enlarged uterus (in this case, 28 weeks' gestational size). Suction evacuation is a safe and effective method for emptying the uterus in cases of molar pregnancy. It allows for the removal of the molar tissue while minimizing the risk of bleeding and preserving future fertility. This method is preferred over medical treatment or hysterectomy, especially in younger women or those who wish to retain their fertility.

## **Why Each Wrong Option is Incorrect**
- **Option A:** Medical treatment might not be effective in cases of significantly enlarged uterus due to molar pregnancy. It is not the primary treatment for molar pregnancy with a large uterus.
- **Option B:** While dilation and curettage (D&C) can be used for smaller uteri, suction evacuation is generally preferred for larger uteri due to its effectiveness and lower risk of complications.
- **Option C:** Hysterectomy is a definitive treatment but is usually reserved for women who do not desire future fertility. It is not considered the first-line treatment for a woman of reproductive age with a molar pregnancy, especially if future fertility is desired.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that following the evacuation of a molar pregnancy, **serum beta-hCG levels should be monitored** until they return to normal to ensure complete removal of the molar tissue and to early detect any potential progression to gestational trophoblastic neoplasia (GTN).

## **Correct Answer:** **D. Suction evacuation**