This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: General obstetrics, Subject name: Gynaecology & Obstetrics
[{'content': 'Indication of methotrexate in molar pregnancy: \nSelect and explain. \nA. Fetal hea activity present, B. Theca lutein cysts size <4cm, C. P-hCG 4000 MlU\\/ml, D. Evidence of metastasis', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Indications for chemotherapy in GTD histological evidence of choriocarcinoma Evidence of metastasis in brain ,liver,GIT,or radiological opacities >2 cm on chest x-ray Pulmanory ,vulval or vaginal metastases unless serum beta hcg is falling Heavy vaginal bleeding or evidence of gastrointestinal or intraperitoneal haemorrhage Rising serum beta HCG values after evacuation Serum beta hCG >20,000 IU/L more than 4 weeks after evacuation because of the risk of uterine perforation (refer pgno:172 sheila textbook of obstetrics 2 nd edition)', 'role': 'assistant'}]