Evacuation in molar pregnancy

• Suction evacuation is recommended for molar pregnancy EXCEPT for partial moles when the size of fetal parts makes suction evacuation inappropriate. 
The same applies to twin pregnancies with one molar pregnancy. 

Otherwise medical evacuation should be avoided due to the risk of trophoblast emboli causing metastatic disease

• Use of mifepristone and misoprostol should be avoided in complete molar pregnancies

• Cervical preparation immediately prior to evacuation is safe. However, prolonged preparation with prostaglandins should be avoided

• Avoid use of uterotonic agents before the uterus is empty. 

In the event of heavy vaginal bleeding, evacuation should be expedited and the use of oxytocin balanced against the risk of embolisation.

• Decisions on chemotherapy should be based on the FIGO prognostic score