Gestational Trophoblastic Disease (GTD)

Question 1

What is it?

Answer 1

Range of conditions involving chromosomally abnormal pregnancies and placental overgrowth

Question 2

Hydatidiform mole (aka molar pregnancy):

Generally, what is it?

2 types:

• Complete molar pregnancy - what is it?
• Partial molar pregnancy - what is it?

Answer 2

Premalignant condition, with ‘mole’ referring to clump of cells

All the genetic material comes from the father, due to single sperm fertilizing an empty ovum and duplicating to become diploid

Triploid, due to 2 sperm fertilising one ovum

Question 3

Gestational trophoblastic neoplasia:

What is it?

Answer 3

Molar pregnancies becoming malignant

Choriocarcinoma
Invasive mole
Placental site tumour
Epitheloid tumour

Question 4

Presentation:

Sym in 1st trimester

What may differ about the uterus and the dates of pregnancies compared to a normal pregnancy?

Why do they get pain?

What other preg complications may they present with?

What could they get thyrotoxicosis, same as in any pregnancy?

Answer 4

Bleeding

Large for dates uterus

Hyperstimulation of ovarian cyst

HG and pre-eclampsia

Beta-hCG mimicking TSH

Question 5

Risk factors - 2

What ethnicity is it more common in?

Answer 5

Extremes of reproductive age
Past history of GTD

Asian ethnicity

Question 6

Investigations:

Test to confirm preg first of all

What may the pregnancy look like on TVUS?

What may be seen on the ovaries?

What may the partial mole show?

How can it be confirmed in the first trimester if they miscarry?

What imaging is used for staging of suspected mets?

Answer 6

Urine + serum beta-hCG

‘Snowstorm appearance’ - look up

Large theca lutein cysts

The viable but abnormal foetus

Histology

CXR, CT and MRI

Question 7

Management:

How is the molar pregnancy removed?

What is given if they are discovered to be Rhesus negative?

What can be offered if they aren’t considering further pregnancies?

What is there is a viable twin?

Answer 7

Suction dilation and evacuation

Anti-D immunoglobulins

Hysterectomy

Conservative Rx but monitor closely and advice that only 25% will remain viable

Question 8

Long-term surveillance:

Why is it done?

How is it done?

What should be avoided during this time?

In persistent GTD, what may be needed?

Answer 8

To check for persistent GTD

Beta-hCG every 2 wks, until levels normalise
Followed by monthly testing for 6 months

Conceiving so they are advised to go on contraception

Chemotherapy