Table Poor prognosis is also suggested by the following (National Institutes of Health [NIH] criteria): Urinary hCG excretion > 100, 000 IU in 24 hours Duration of disease > 4 months (interval since prior pregnancy) Brain or liver metastases Disease after full-term pregnancy Serum hCG > 40, 000 mIU / mL Unsuccessful prior chemotherapy WHO score > 6 Treatment of Gestational Trophoblastic Disease Tumor removal by suction curettage or hysterectomy (if fertility is not desired, especially if women > 40 years) Further evaluation for persistent disease and spread of tumor Chemotherapy for persistent disease Posttreatment contraception for persistent disease (See also National Comprehensive Cancer Network (NCCN): NCCN Clinical Practice Guidelines in Oncology: Gestational Trophoblastic Neoplasia.)