Gestational trophoblastic disease Flashcards
Define gestational trophoblastic disease.
Group of disorders spanning complete + partial molar pregnancies through to malignant conditions
What are the 2 pre-malignant manifestations of GTD?
Complete hydatidiform mole
Partial hydatidiform
Give 4 malignant manifestations of GTD
Invasive mole
Choriocarcinoma
Placental site trophoblastic tumour (PSTT)
Epithelioid trophoblastic tumour
What are complete molar pregnancies?
Empty egg fertilized by a single sperm that then duplicates its own DNA, hence all 46 chromosomes are of paternal origin
No evidence of fetal tissue
What is a partial molar pregnancy?
Normal haploid egg fertilized by 2 sperms, or by 1 sperm with duplication of the paternal chromosomes.
DNA is both maternal + paternal in origin.
Usually triploid e.g. 69 XXX or 69 XXY.
Fetal parts may be seen
Explain the aetiology of gestational trophoblastic disease.
Abnormal chromosomal material of placental tissue.
Invasive moles always form from hyatidiform nuclei.
Choriocarcinoma often after molar pregnancy, viable, miscarriage or ectopic.
What are the risk factors for gestational trophoblastic disease?
Extreme of age
Previous GTD
Ethnicity (Asian)
What is an invasive mole?
develops from a complete mole + invades the myometrium.
List 4 symptoms of a molar pregnancy
Persistent/ irregular PV bleed
+ve pregnancy test
Hyperemisis
Lower abdo pain.
List 3 signs molar pregnancy
Uterine large for dates
Signs of hyperthyroidism
HTN
Why do signs of hyperthyroidism occur in molar pregnancy?
bHCG can act on Thyroid stimulating hormone receptors at high concentrations
What is seen on bloods in molar pregnancy?
Very high serum bHCG
What is seen on USS in molar pregnancy?
Complete: “SNOWSTORM” or “Bunch of GRAPES”
Partial: enlarged placenta + cystic changes
What is the investigation for definitive diagnosis of molar pregnancy?
Histological exam
What is the management plan for molar pregnancies?
urgent referral to specialist centre: evacuation via Suction curettage
effective contraception is recommended to avoid pregnancy in the next 12 months