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Obstetrics > Early pregnancy: Gestational Trophoblastic Disease > Flashcards

Early pregnancy: Gestational Trophoblastic Disease Flashcards

1
Q

What is gestational trophoblastic disease

A

pregnancy-related tumours

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2
Q

How can gestational trophoblastic disease be divided

A
  1. Pre-malignant conditions

2. Malignant conditions

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3
Q

What is pre-malignant gestational trophoblastic disease

A

Partial and complete molar pregnancies

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4
Q

What are malignant gestational trophoblastic disease

A

Choriocarcinoma, Invasive mole,

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5
Q

Explain chromosomes in normal fertilisation

A

Normally 23 from mother and 23 from father

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6
Q

What causes a molar pregnancy

A

Abnormality in foetal chromosomes

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7
Q

What is a partial molar pregnancy

A

There is one ova (23 chromosomes) fertilised by two sperm (each 23 sperm). Gives 69 chromosomes in total = triploidy.

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8
Q

What is a complete molar pregnancy

A

One ova (with 0 chromosomes) is fertilised by one sperm which then duplicates. Giving 46 chromosomes all male in origin.

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9
Q

What are partial and complete molar pregnancies called

A

Hydratidiform moles

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10
Q

What are invasive moles

A

Usually benign, but can become malignant by invading myometrium.

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11
Q

What is a choriocarcinoma

A

Malignancy of trophoblastic cells

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12
Q

What does choriocarcinoma often originate from

A

molar pregnancy

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13
Q

What metastses are common in choriocarcinoma

A

Lung

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14
Q

What are hydratidiform mole

A

tumours arise from proliferating chorion that has swollen and degenerated

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15
Q

What are the two types of hydratidiform mole

A
  1. Complete mole

2. Partial mole

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16
Q

How does complete hydratidiform mole present

A

Hydropic villi

17
Q

What causes complete hydratidiform mole

A

One ova with 0 chromosomes is fertilised by one sperm, whose chromosomes then duplicated. Giving total 46 chromosomes, but they are all paternal

18
Q

How does a partial hydratidiform mole present

A

Normal and hydropic villi

19
Q

What causes a partial mole

A

One ova with 23 chromosomes is fertilised by two sperm (23 chromosomes) giving 69 chromosomes = triploidy

20
Q

What are 5 risk factors for hydratidiform mole

A
  1. <15 and >45
  2. Asian
  3. Previous gestational trophoblast disease (even if different partner)
  4. previous miscarriage
  5. COCP
21
Q

How does hydratidiform mole present clinically

A
  • Irregular bleeding in first trimester (90%)
  • Uterus large for dates
  • Pain = due to bHCG causing enlargement theca cysts
  • Exaggerated symptoms pregnancy = due to bHCG
22
Q

Where are hydratidiform mole derived from and what does this cause

A

Chorion - excess bHCG secretion

23
Q

What is used as a investigation for hydratidiform mole

A

bHCG = markedly raised out of proportion to gestation age

24
Q

What is second-line investigation for hydratidiform mole

A

Transvaginal US

25
Q

How does complete hydratidiform mole present on transvaginal US

A

Snowstorm appearance - due to echogenic mass with hypoecogenic cystic spaces

26
Q

How may partial hydratidiform mole present

A

Foetus may be visible.
IUGR
Thickened placenta

27
Q

What is required to confirm diagnosis of hydratidiform mole

A

Histological diagnosis of products of conception

28
Q

How are complete hydratidiform moles managed

A

Surgical evacuation and oxytocin to control haemorrhage

29
Q

How are partial hydratidiform moles managed

A

Surgical evacuation

30
Q

Define choriocarcinoma

A

Malignancy of chorio and synctiotrophoblasts

31
Q

When can choriocarcinomas only develop

A

only after ova has been fertilised and implanted

32
Q

What precedes 50% of choriocarciomas

A

hydratidiform mole

33
Q

What is the most common sign of choriocarcinoma

A

failure of uterus to regress following delivery

34
Q

What is a symptom of choriocarcinoma

A

post-partum bleeding

35
Q

What is the most common site of metastses of choriocarcinoma

A

lungs

36
Q

How is choriocarcinoma managed

A

chemotherapy

Obstetrics (27 decks)

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