Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gaby’s Green Top Guidelines > 2020 38 Gestational Trophoblastic Disease > Flashcards

2020 38 Gestational Trophoblastic Disease Flashcards

1
Q

** What are the common signs & symptoms of molar pregnancies? **

A
  1. Irregular PV bleeding
  2. Positive pregnancy test
  3. Ultrasonographic evidence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

** What are the less common presentations of molar pregnancies? **

A
  1. Hyperemesis
  2. Excessive uterine enlargement
  3. Hyperthyroidism
  4. Early-onset pre-eclampsia
  5. Abdominal distensión by theca lutein cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

** What are the very rare presentations of molar pregnancy? **

A
  1. Haemoptysis due to lung mets
  2. Seizures due to brain mets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

** How is molar pregnancy definitively diagnosed? **

A

Histology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

** What method should be used for removal of a molar pregnancy? **

A
  1. Complete molar: suction curettage
  2. Consider US guidance to minimise chance of perforation or RPOC
  3. Partial molar: suction curettage unless fetal parts too big, then medical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

** What surgical considerations are there for molar pregnancy removal? **

A
  1. Anti-D prophylaxis after
  2. Cervical preparation is safe
  3. Oxytocin infusion not recommended due to risk of tissue embolisation
  4. Senior consideration of oxytocin if significant haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

** When should repeat surgical removal be done for molar pregnancy? **

A
  1. Urgent if heavy or persistent PVB causing acute haemodynamic instability
  2. RPOC on USS
  3. If not acutely compromised, involve GTD referral centre
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

** How should GTD be excluded following miscarriage? **

A
  1. Histological assessment of all, if no fetal parts identified at any stage of pregnancy
  2. UPT at 3 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

** How should GTD be excluded following abortion? **

A
  1. No need to routinely send if fetal parts identified in prior USS
  2. UPT at 3 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

** How should elevated hCG after a possible pregnancy be managed? **

A

Referral to GTD centre, provided
1. Ectopic pregnancy excluded, or
2. 2 consecutive treatments with methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

** Who should be investigated for GTN after a non-molar pregnancy? **

A
  1. Persistent PVB: urine hCG in all lasting more than 8 weeks
  2. Symptoms of mets including dyspnoea, haemoptysis, new onset seizures or paralysis
    NB Do not biopsy secondary deposits in vagina as can cause major haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

** How should suspected ectopic molar pregnancy be managed? **

A
  1. As other ectopic pregnancy
  2. Send pregnancy tissue to a centre with appropriate expertise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

** How is twin pregnancy of a viable fetus & coexistente molar managed? **

A
  1. If diagnosed or suspected, refer to FMU & GTD centre
  2. Counselling about increased risk of perinatal mortality
  3. Consider prenatal invasive testing: complete mole with coexisting normal vs singleton partial molar
  4. Also for suspected mesenchymal hyperplasia of placenta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

** Which women should be registered at GTD centres? **

A
  1. Complete or partial molar
  2. Twin with complete or partial molar
  3. Limited macro or microscopic change suggesting early complete or partial molar or choriocarcinoma
  4. PSTT: placental site trophiblastic tumour
  5. ETT: epithelial trophoblastic tumour
  6. Atypical PSN: placental site nodule
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

** What is the optimum follow-up following a diagnosis of GTD? **

A
  1. Complete, hCG normal after 56 days ➡️ 6 months from uterine removal
  2. Complete, not normal after 56 days ➡️ 6 months from hCG normalisation
  3. Partial: after 2 normal hCG samples, > 4 weeks apart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

** What is the optimum treatment for GTN? **

A
  1. Single-agent or multi-agent chemo
  2. Base Tx on FIGO 2000 scoring system
  3. PSTT & ETT less sensitive to chemo so treated surgically
17
Q

** What are the recommendations for future pregnancy after GTD? **

A
  1. Do not TTC until follow-up complete
  2. > 1 year following chemotherapy
  3. Do not need histology or post-preg hCG from subsequent normal pregnancy if not treated for GTN
18
Q

** What is the long-term outcome of women treated for GTN? **

A
  1. Overall cure rate close to 100%
  2. Further pregnancies in approx 80% following either methotrexate or multi-agent chemo
  3. Increased risk of premature menopause if combination agent chemo
19
Q

** What are the implications of GTD for subsequent a) contraception, b) fertility drugs, c) HRT

A

a) most contraception OK, wait until hCG normalised before coil
b) fertility drugs safe once hCG normalised
c) HRT safe once hCG normalised

Gaby’s Green Top Guidelines (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions