ABSTRACT
For the small minority whose hCG levels remain elevated following chemotherapy, more definitive surgical management may be required in the form of a total abdominal hysterectomy. Elevated hCG levels predispose to ovarian cyst formation but this should not encourage bilateral oophorectomy at the time of the hysterectomy unless there is another pre-existing reason. Total abdominal hysterectomy in the presence of choriocarcinoma can prove very taxing. Uterine vascularity may be massively increased, presumably owing to the action of vasoactive peptides, etc., and the uterine arteries may be up to 1 cm in diameter. More troublesome still is the massive enlargement of the uterine venous plexus. This can lead to hemorrhage during ureteric dissection, particularly in cases where the tumor has spread beyond the uterus into the parametrium.
