Gestational Trophoblastic Disease

Question 1

Which part of the developing ovum grows abnormally in hydatidiform mole?

Answer 1

Answer: Trophoblast, which is the outer layer of the blastocyst that plays a crucial role in the implantation of the embryo into the uterine wall and eventually forms the placenta.

Question 2

What are the two types of H. mole and what is the difference between the two?

Answer 2

Complete – no fetus present

Partial – contains fetal tissue or membranes

Question 3

Name the signs and symptoms of H. MOLE

Answer 3

Massive uterus

Overproduction of hCG causing extreme nausea and vomiting

Light to heavy vaginal bleeding

Early onset of pre-eclampsia

Question 4

The doctor prescribes IV oxytocin to start running while the patient is being prepped for surgical evacuation of the mole. Would you give this? Why or why not?

Answer 4

Question the order and not give the drug. Drugs that induce uterine contractions should not be given before evacuation of moles because of the risk of releasing trophoblastic tissue into the circulation.

Question 5

What is the follow-up protocol after initial treatment of H.mole and why is this is important?

Answer 5

Follow-up should be done to detect any malignant changes in remaining trophoblastic tissue. The protocol is to measure serum beta HCG levels every 1 to 2 weeks until three normal pre-pregnancy levels are attained, This is repeated every 1 to 2 months for up to a year.

Question 6

A woman who has just been treated wit H. mole asks you if she can try for another baby after discharge. What is your response?

Answer 6

Pregnancy should be avoided during follow-up and until choriocarcinoma is ruled out because evidence of this malignancy is obscured by pregnancy.