Bleeding in Early Pregnancy Flashcards
What disorders are included in gestational trophoblastic disease (GTD)?
- Complete molar pregnancy
- Partial molar pregnancy
- Invasive mole
- Choriocarcinoma
- Placental site trophoblastic tumor (PSTT).
What is gestational trophoblastic neoplasia (GTN)?
A condition characterized by a persistent elevation of βhCG after GTD.
How are molar pregnancies classified?
Based on genetic and histopathological features.
- Complete moles (CM)
- Partial moles (PM)
What is the genetic origin of complete moles?
Diploid and androgenic, with no fetal tissue evidence.
What is the most common cause of complete moles?
Duplication of a single sperm after fertilization of an empty ovum.
What is the genetic origin of partial moles?
Triploid, with two paternal haploid and one maternal haploid gene sets.
List some clinical presentations of GTD.
- Irregular vaginal bleeding
- Hyperemesis
- Excessive uterine enlargement
- Early failed pregnancy.
What systemic symptoms can GTD cause?
- Hyperthyroidism
- Early pre-eclampsia
- Abdominal distension due to theca lutein cysts.
How is GTD diagnosed using ultrasound?
- Characteristic “honeycomb” or “snowstorm” appearance
- Presence of theca lutein cysts.
What βhCG level is suggestive of GTD?
Levels greater than two multiples of the median.
How is the definitive diagnosis of molar pregnancy made?
Through histological examination of the products of conception.
What is the method of choice for evacuating a complete molar pregnancy?
Suction curettage.
Is medical evacuation recommended for complete molar pregnancies?
No, it is avoided if possible.
What precautions are taken during evacuation of molar pregnancies?
- Senior supervision
- Avoiding oxytocic infusion prior to completion of evacuation.
Why is Anti-D prophylaxis required after molar pregnancy evacuation?
To prevent isoimmunization.
When is a second uterine evacuation recommended in GTD?
Only if symptoms persist, and after consultation with a trophoblastic screening center.
What should be done for women with persistent bleeding post-pregnancy event?
A urine pregnancy test to rule out GTN.
How long is the follow-up after GTD if βhCG normalizes within 56 days?
6 months from uterine evacuation.
How long should women with GTD avoid pregnancy after follow-up?
Until follow-up is complete or chemotherapy is concluded.
Around 1 year
What chemotherapy regimen is used for low-risk GTN (FIGO score ≤ 6)?
Single-agent methotrexate with folinic acid.
What chemotherapy is used for high-risk GTN (FIGO score ≥ 7)?
Multi-agent chemotherapy including:
- methotrexate
- cyclophosphamide
- vincristine.
What is the treatment approach for PSTT?
Surgery, as it is less sensitive to chemotherapy.
What long-term risk is associated with multi-agent chemotherapy in GTN?
Increased risk of secondary cancers like AML, colon cancer, and melanoma.
What contraceptive methods are recommended post-GTD treatment?
Barrier methods until βhCG normalizes, then oral contraceptive pills.
What is the effect of chemotherapy on menopause in GTN patients?
Accelerated menopause, earlier by 1–3 years depending on the regimen.
When should hCG levels be measured after future pregnancies in GTD patients?
6–8 weeks postpartum to exclude recurrence.
Why should intrauterine devices be avoided in GTD patients until βhCG normalizes?
To reduce the risk of uterine perforation.
What imaging feature differentiates partial from complete molar pregnancies?
Evidence of fetal tissue or red blood cells in partial moles.
What histological features are seen in complete moles?
- Trophoblastic hyperplasia without fetal tissue
- Edematous villi
- Swollen chorionic villi.
What histological features are seen in partial moles?
- Some fetal tissue present
- Trophoblastic proliferation
- Edema
- Mix of normal and abnormal villi.
