Bleeding in Early Pregnancy Flashcards

1
Q

What disorders are included in gestational trophoblastic disease (GTD)?

A
  1. Complete molar pregnancy
  2. Partial molar pregnancy
  3. Invasive mole
  4. Choriocarcinoma
  5. Placental site trophoblastic tumor (PSTT).
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2
Q

What is gestational trophoblastic neoplasia (GTN)?

A

A condition characterized by a persistent elevation of βhCG after GTD.

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3
Q

How are molar pregnancies classified?

A

Based on genetic and histopathological features.

  1. Complete moles (CM)
  2. Partial moles (PM)
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4
Q

What is the genetic origin of complete moles?

A

Diploid and androgenic, with no fetal tissue evidence.

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5
Q

What is the most common cause of complete moles?

A

Duplication of a single sperm after fertilization of an empty ovum.

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6
Q

What is the genetic origin of partial moles?

A

Triploid, with two paternal haploid and one maternal haploid gene sets.

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7
Q

List some clinical presentations of GTD.

A
  1. Irregular vaginal bleeding
  2. Hyperemesis
  3. Excessive uterine enlargement
  4. Early failed pregnancy.
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8
Q

What systemic symptoms can GTD cause?

A
  1. Hyperthyroidism
  2. Early pre-eclampsia
  3. Abdominal distension due to theca lutein cysts.
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9
Q

How is GTD diagnosed using ultrasound?

A
  1. Characteristic “honeycomb” or “snowstorm” appearance
  2. Presence of theca lutein cysts.
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10
Q

What βhCG level is suggestive of GTD?

A

Levels greater than two multiples of the median.

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11
Q

How is the definitive diagnosis of molar pregnancy made?

A

Through histological examination of the products of conception.

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12
Q

What is the method of choice for evacuating a complete molar pregnancy?

A

Suction curettage.

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13
Q

Is medical evacuation recommended for complete molar pregnancies?

A

No, it is avoided if possible.

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14
Q

What precautions are taken during evacuation of molar pregnancies?

A
  1. Senior supervision
  2. Avoiding oxytocic infusion prior to completion of evacuation.
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15
Q

Why is Anti-D prophylaxis required after molar pregnancy evacuation?

A

To prevent isoimmunization.

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16
Q

When is a second uterine evacuation recommended in GTD?

A

Only if symptoms persist, and after consultation with a trophoblastic screening center.

17
Q

What should be done for women with persistent bleeding post-pregnancy event?

A

A urine pregnancy test to rule out GTN.

18
Q

How long is the follow-up after GTD if βhCG normalizes within 56 days?

A

6 months from uterine evacuation.

19
Q

How long should women with GTD avoid pregnancy after follow-up?

A

Until follow-up is complete or chemotherapy is concluded.
Around 1 year

20
Q

What chemotherapy regimen is used for low-risk GTN (FIGO score ≤ 6)?

A

Single-agent methotrexate with folinic acid.

21
Q

What chemotherapy is used for high-risk GTN (FIGO score ≥ 7)?

A

Multi-agent chemotherapy including:

  • methotrexate
  • cyclophosphamide
  • vincristine.
22
Q

What is the treatment approach for PSTT?

A

Surgery, as it is less sensitive to chemotherapy.

23
Q

What long-term risk is associated with multi-agent chemotherapy in GTN?

A

Increased risk of secondary cancers like AML, colon cancer, and melanoma.

24
Q

What contraceptive methods are recommended post-GTD treatment?

A

Barrier methods until βhCG normalizes, then oral contraceptive pills.

25
Q

What is the effect of chemotherapy on menopause in GTN patients?

A

Accelerated menopause, earlier by 1–3 years depending on the regimen.

26
Q

When should hCG levels be measured after future pregnancies in GTD patients?

A

6–8 weeks postpartum to exclude recurrence.

27
Q

Why should intrauterine devices be avoided in GTD patients until βhCG normalizes?

A

To reduce the risk of uterine perforation.

28
Q

What imaging feature differentiates partial from complete molar pregnancies?

A

Evidence of fetal tissue or red blood cells in partial moles.

29
Q

What histological features are seen in complete moles?

A
  • Trophoblastic hyperplasia without fetal tissue
  • Edematous villi
  • Swollen chorionic villi.
30
Q

What histological features are seen in partial moles?

A
  • Some fetal tissue present
  • Trophoblastic proliferation
  • Edema
  • Mix of normal and abnormal villi.