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Previous Volume 360:1639-1645 April 16, 2009 Number 16 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.

A healthy 37-year-old woman presents at 10 weeks of pregnancy with vaginal bleeding. Physical examination shows that the uterine size is appropriate for gestational age. The level of serum human chorionic gonadotropin (hCG) is 22,000 mIU per milliliter. Ultrasonography does not show an identifiable fetal heartbeat. After receiving a clinical diagnosis of missed abortion, the patient undergoes evacuation of the uterus; pathological . . . [Full Text of this Article]

The Clinical Problem

Strategies and Evidence

Diagnosis

            Ultrasonographic Examination

            Measurement of hCG

            Challenges of Pathological Diagnosis

Management

Persistent Neoplasia after a Molar Pregnancy

Monitoring of hCG after Evacuation of the Mole

Subsequent Pregnancy

Areas of Uncertainty

Guidelines

Conclusions and Recommendations

Source Information

From the New England Trophoblastic Disease Center, Trophoblastic Tumor Registry; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital; the Dana–Farber Cancer Institute; and Harvard Medical School — all in Boston.

An audio version of this article is available at NEJM.org.

Address reprint requests to Dr. Berkowitz at the Division of Gynecologic Oncology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or at rberkowitz@partners.org.

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