gestational trophoblastic disease

Question 1

gestational trophoblastic disease

Answer 1

• term used to describe a group of pregnancy related tumours

- cells that form gestational trophoblastic tumours are called trophoblasts and form the placental tissue

Question 2

GTD subtypes ;

Answer 2

1. benign tumour - Hydatidiform mole
2. malignant tumours
   - invasive mole
   - Choriocarcinoma
   - trophoblastic tumors

Question 3

Hydratidiform mole/Molar pregnancy definition

Answer 3

1. abnormal form of pregnancy where an unviable fertilised egg implants in the uterus
2. a form of gestational trophoblastic disease
3. grows into a mass in the uterus with swollen chorionic villi –> resemble grape clusters

Question 4

complete molar pregnancy

7

Answer 4

1. single sperm fertilises egg without a nucleus
2. Paternal dna only, will duplication
3. 46,XX/46YY
4. No fetal tissue present
5. 2% chance of choriocarcinoma conversion
6. increase in hCG
7. increase in uterus size

Question 5

partial molar pregnancy (5)

Answer 5

1. 69 , XXX, XYY, XXY
2. One egg is fertilised by 2 x sperm ; maternal and extra paternal genetic material
3. rise in hCG
4. no risk of choriocarcinoma
5. fetal tissue present ( amnion/rbcs)
6. uterus is normal size for gestational age

Question 6

pathophys of molar pregnancy

Answer 6

1. nonviable fertilised ovum implants in uterus
2. paternal genes are over expressed
3. trophoblastic proliferation
4. vesicular placental villi swelling
   5 . non viable pregnancy

Question 7

symptoms of complete molar pregnancy (5)

Answer 7

1. missed menstrual periods
2. Enlarged uterus/pelvic pressure
3. High hCG levels;
   - positive pregnancy test
   - Hyperemesis gravidarum
   - mimics TSH -> - Hyperthyroidism ( tachycardia/warm skin / tremor )
   - Theca lutein cysts ( mimics FSH/LH)
4. First trimester uterine bleeding ( dark, prune juice coloured discharge)
   - v irregular + heavy
5. Pre eclampsia ( high bp )

Question 8

Investigations and diagnosis for complete molar pregnancy

Answer 8

1. Bimanual examination - assess uterine size
2. Transvaginal ultrasound :
   - no embryo/fetus/fetus heart beat
   - snowstorm/bunch of grapes/swiss cheese pattern within uterus
   - Theca lutein cysts
3. Chest x ray for metastases
4. Lab results
   - increased hCG
   - blood type - high potential of bleeding and FBC for anaemia
   - RH testing

Question 9

investigations and diagnosis for incomplete molar pregnancies

Answer 9

1. fetus may be identified
2. amniotic fluid is present
3. no theca lutein cysts

Question 10

treatment for complete molar pregnancies

Answer 10

1. uterine suction/surgical curettage to scrape out the tumor to avoid risk of choriocarcinoma
2. prophylactic chemotherapy with methotrexate/actinomycin D to prevent further development of choriocarcinoma
3. Surgery - Hysterectomy

Question 11

follow up of molar pregnancy

Answer 11

1. periodic management of hCG levels at regular intervals (weekly) and reliable contraception until hCG is undetectable
2. avoid pregnancy straight after as 1% chance of second molar