Gestational Trophoblastic Diseases Flashcards
Mention investigations of molar pregnancy
US is the gold standard
In case of complete mole characteristic sonw storm appearance surrounded of blood
Absence of fetal echoes
In case of partial mole cystic changes in placenta and presnce of fetal echoes
Theca lutin cysts multiple &variable sized thin walled cysts
Pregnancy tests very high levels of BHCG May reach 100000 in 8_10 wks which is higher than normal pregnancy in the same gestational age
Abdominal us for liver metastasis
Chest Xray to exclude lung metastasis
Ct head , abdomen ,chest if indicated
Pretreatment tests
Baseline liver and renal function tests .CBC and congratulation profile
Thyroid function tests if clinical hyperthyroidism is suspected
What is ttt of molar pregnancy
Stabilizing patient general condition:saline and lactated ringer infusion . Blood transfusion in severely anemic patients
Gold standard ttt is suction evacuation through 12mm cannula or larger catheter may be indicated in case of partial mole with fetus more than 12mm
Misoprostol prior to evacuation to help evacuation prior through cervical dilatation
Iv oxytocin during evacuation to decrease bleeding
Hysterectomy may be indicated in some cases
The follow up is needed
If B HCG curve is rising or plateau or not turn _ve for >6 months
That may require chemotherapy
Mention cases need hysterectomy as a ttt for molar pregnancy
Older multiparous women desiring sterilisation
Multiparous women with severe bleeding and infection
Patients with invasive mole
Do patients with hysterectomy need FUP
YES, hysterectomy prevents local invasion but not preventing distant metastasis
When there is a need of chemotherapy as a ttt of complete mole
When there is post molar B HCG abnormal curves
Plateau level , rising level
Not turn -ve for >6 months
Chemotherapy may be used as a prophylactic in patients for whom compliance with B HCG follow up may be difficult or who have any of the following high risk factors:
1)B HCG level over 100000
2)Presence of large theca lutin >6 cm in diameter
3)Significant uterine enlargement
Drug used methotrexate or dactinomycin
Women should be advised not to conceive untill …
Mention the methods of contraception used
1- Their follow up is complete
2- 1 year after completion of ttt for women who undergo chemotherapy
____________________________________________________
Women shoud be advised to usebarriermethods untill B hcg levels revert to normal
Once B hcg levels are normalized combined oral contraceptive pills is the preferred method of contraception
IUD shouldn’t be used as it cause vaginal bleeding that may interferes with the FUP
What are risk factors for molar pregnancy
1) extreme of ages >35 especially 50 and<15
2) previous molar pregnancy recurrence risk in next pregnancy 1-2%
3) nutritional deficiency loe intake of vit A and animal fat
Mention morphology of complete mole
A punch of grape appearance
Symmetrically enlarged soft uterus
Filled é vesicles contain watery fluid, few millimeter to fee centimetres in diameter
Contain no amniotic sac nor fetus
Mention morphology of partial mole
Hydatidiform cahanges are focal
Amniotic sac or fetus can be identified
When the fetus is present it exhibit the stigmata of triploidy including growth restriction and multiple congenital malformation
What is the fate of theca lutin cyst
It mostly undergoes spontaneous regression within 2-4wks after evacuation of vesicular mole
Large cysts may undergo tortion, hge & infarction
Microscopic changes of vesicular mole are
Marked edema and enlargement of villios stroma
Trophoblastic hyperplasia
What are the complications of molar pregnancy
3 ==>hyper. CIEB سايبDIC RDS
hypertension and pre ecampsia
Hyperemesis gravidarum
Hyperthyroidism due to thyroid stimulating effect of B.hcg
Theca lutin cyst complication tortion hge and infarction
Infection during evacuation
Trophoblastic embolization to the lung
Bleeding that may cause anemia and may be life threatening
DIC due ti hypertension hyperemesis gravidarum infection bleeding
RDS Dt hypertension trophoblastic embolization to the lung hyperthyroidim excessive fluid therapy
GTN & Recurrence
Invasive mole 20%
Choriocarcinoma 5%
Recurrence in subsequent pregnancy 1-2%
Mention symptoms of molar pregnancy
Amenorrhea positive pregnancy test
Recurrent Vaginal bleeding
dark prune juice like discharge
Pain that may be colicky dt uterine contraction
Dull aching pain dt uterine distesion
Sharp in case of complicated ovarian cyst and invasive mole
Severe nausea and vomiting
Signs of molar pregnancy
General examination pallor and signs of complications DIC, RDS HTN
Abdominal
Uterus soft and doughy sensation
Fundus above the date 25-50. Below 25-30
Fetus pulsation -ve
Pelvic examination
Uterus… same as above
Cervix… soft , bleeding and passage of vesicles
Adnexia bilateral cystic ovaries
Partial mole present è picture of
Incomplete or missed abortion
