GTD

Question 1

Suspected molar investigations

Answer 1

t-hcg
FBC
Group & Hold
TFTs, LFTs, coag
CXR

Question 2

molar management

Answer 2

ERPOC
avoid oxytotic-may increase risk emobolisation
Products to histology
Refer to molar pregnancy clinc/registry
MDT R/V if pathology unclear

Question 3

information for patient post molar pregnancy

Answer 3

Dx
F/u - risk persistent disease
Avoid getting pregnant til advised - barrier contraception
Risk future pregnancy 1:70
F/u hcg 6/52 post any pregnancy
Fertility rate not effected

Question 4

follow up hcgs post partial and complete

Answer 4

weekly thcg until normal x 3 (then stop for partial)

monthly for 6/12 post molar

Question 5

Choriocarcinoma, PSTT, ETT

Answer 5

MDT R/V
CT head, chest abdo pelvis
MRI head if neurological symptoms
Refer Gynae onc
WHO Risk score >7 (HR protocol) -EMACO (actinomycin, etoposide, MTX)
WHO risk score < 7 (LR protocol); MTX folinic acid
Chemo until hcg normalises then 3 more rounds
monthly hcg for a year

Question 6

Treatment regimes for GTD

Answer 6

MTX with folinic acid WHO <7

EMACO (WHO>7) (etoposide, MTX actinomycin, cyclophosphamide, vincristine)

Question 7

molar pregnancy

Answer 7

a rare complication of pregnancy characterized by the abnormal growth of cells that usually form the placenta. This is not a viable pregnancy. Treatment involves removal of the abnormal tissue and ongoing follow up as some of the tissue can continue to grow and has the potential to develop into a cancer.