QUESTION 40

 

A 38-year-old woman, gravida 1 aborta 1, comes to the office for follow-up a week after suction curettage The patient initially
presented 7 weeks after her last menstrual period for an initial prenatal appointment At that time, she had breast tenderness but no
abdominal pain, nausea, or vaginal bleeding. During that visit, ultrasound revealed an empty gestational sac. 13-hCG level was
53,256 IU/L. The patient returned a week later and repeat ultrasound confirmed a missed abortion. Suction curettage was performed
and the pathological specimen from the procedure indicated a diagnosis of hydatidiform mole. Today, the patient has minimal
bleeding but no pain, fevers, chills, or abnormal vaginal discharge Blood pressure is 110/80 mm Hg and weight is 55 kg (121.3 lb).
Pelvic examination shows minimal dark red blood in the vaginal vault and no active bleeding. On bimanual examination, the uterus is
small and nontender. No adnexal masses are palpated 13-hCG level is 1,412 IU/L. Which of the following is the best next step in
management of this patient?
QA Chemotherapy
0 B. Contraception for at least 6 months
0 C. Hysterectomy
0 D. Parental karyotype
0 E. Repeat suction curettage
0 F. Serial CA-125 levels