Gestational trophoblastic disease

Question 1

What is gestational trophoblastic disease

Answer 1

abnormal proliferation of trophoblastic tissue of placenta 2/2 abnormal fertilization

Question 2

RF for GTD are

Answer 2

previous molar pregnancy
AMA (>40)
Asian/American Indian

Question 3

What are the 4 types of GTD

Answer 3

Hydatiform mole (*MC)
Invasive mole
Placental site nodule
Choriocarcinoma

Question 4

The pathophys of GTD is

Answer 4

maternal tumor arises from gestational tissue

Question 5

What do paternal genes control

Answer 5

Placental growth!

More of dads genes= more proliferation

Question 6

What are the types of Hydatiform mole (molar pregnancy)

Answer 6

Complete: sperm fertilize an abnormal oocyte (no mom genes) so dads chromosomes duplicate (2 copies of dad)
Partial: 2 sperm fertilize 1 oocyte, so 2:1 paternal:maternal DNA

Question 7

What is an Invasive mole

Answer 7

Villi from a hydatiform molar pregnancy invade deeply into the myometrium of the uterus
Complete>partial

Question 8

What is a placental site nodule

Answer 8

left over tissue after full term pregnancy

Question 9

What is a choriocarcinoma

Answer 9

highly malignant epithelial tumor with widespread mets and vascular invasion, following any type of pregnancy (abortion, ectopic, normal)
Persistent complete hydatiform mole

Question 10

How does GTD present

Answer 10

abnormal uterine bleeding, amenorrhea 
uterine size greater than what it should be for gestation 
absent fetal heart tones 
hyperemesis (HCG is ridiculously high) 
Pre-eclampsia like Sx prior to 20 wks

Question 11

GTD will show these findings on PE/labs

Answer 11

Uterine enlargement +/- adnexal masses
HIGH bHCG
Snow Storm/Grape clusters on US

Question 12

How do you manage a hydatiform mole

Answer 12

D&C to evacuate contents of uterus
Rest pelvis 4-6 wks
Close monitoring of hCG for 6-12 months
AVOID pregnancy for at least 12 months

Question 13

How do you manage choriocarcinoma

Answer 13

Chemotherapy or

Hysterectomy + Chemotherapy