New SBA and EMQ questions on Gestational Trophoblastic Disease

What is the risk of needing chemotherapy following a complete molar pregnancy?

A 37-year-old woman presents to the gynaecology clinic with a 4-month history of irregular vaginal bleeding. She delivered a healthy baby 18 months ago and has had normal menstrual cycles until recently. She reports no pelvic pain, weight loss, or systemic symptoms. A pregnancy test is weakly positive. Serum hCG is mildly elevated at 180 IU/L. Transvaginal ultrasound shows a heterogeneous intrauterine lesion confined to the myometrium without evidence of extrauterine spread. Histological examination following uterine curettage reveals infiltration of the myometrium by intermediate trophoblastic cells, with absence of chorionic villi, consistent with placental site trophoblastic tumour. She is referred to a specialist Gestational Trophoblastic Disease centre. Further investigations including CT scan of the chest, abdomen, and pelvis show no evidence of metastatic disease. Based on findings, she is diagnosed with Stage I placental site trophoblastic tumour (disease confined to the uterus). What is the most appropriate management?

A 29-year-old woman presents to the early pregnancy unit at 10 weeks’ gestation with vaginal bleeding, excessive nausea, and lower abdominal discomfort. She reports that her symptoms have been more severe than in her previous pregnancy. On examination, her uterus is larger than expected for gestational age. Ultrasound demonstrates a “snowstorm” appearance with no identifiable fetus, consistent with a complete molar pregnancy. She undergoes suction evacuation, and histology confirms the diagnosis. She is registered with a specialist trophoblastic disease centre and commenced on fortnightly serum hCG monitoring. Her hCG levels decline steadily but remain detectable beyond 8 weeks post-evacuation. At 10 weeks post-evacuation, her hCG finally returns to normal. What is the recommended duration of follow-up?

A 30 year old woman has surgical management for a missed miscarriage at 10 weeks gestation but represents 3 weeks later with ongoing vaginal bleeding and a positive pregnancy test.  What is the incidence of unrecognised gestational trophoblastic disease prior to removal?