GTD Flashcards
U/s sensitivity of partial vs complete mole?
20% vs 95%
U/s features of partial mole?
-Enlarged placenta/ cystic changes within decidua reaction (w/in placenta)
+
A viable fetus
- transverse anteroposterior diameter of the gestation sac >1.5 are suggestive
Chance of a viable fetus if twin pregnancy with 1 molar pregnancy?
40%
Risks associated. With a twin pregnancy with 1 molar pregnancy?
Increased risk of:
Early pregnancy loss 40%
Preterm birth 36%
Preeclampsia 20%
T/F for twin pregnancy with a molar pregnancy
1. Increased risk of GTN
2. Affects outcomes of chemo
3. Increased need for chemo if pt delivers after 26weeks
- F
- F
- F
Risk of GTN after therapeutic abortion?
1 in 20,000
Treatment for molar pregnancy (complete vs partial)?
Suction curettagebfor both
Can be done under u/s guidance:
Minimises risk of perforation
Removes as much tissue as possible
Role of medical management in treatment?
If fetal size deters the use of suction
OR
With a twin gestation (and 1 molar preganancy), if the woman chooses to terminate or if IUD but rhe fetal size is too big
Cons of using medical management?
1.Higher rates of incomplete removal, thereby increases the risk of GTN and chemotherapy by 16 fold (for complete moles)
2.Risk of embolization and dissemination of trophoblastic tissue in the venous system
- can lead to ARDS
What percent of choricarcinoma were preceded by hydatidiform mole/molar pregnancy?
50%
2-3% of complete moles develop choriocarcinoma
Risk of GTN 8wks after non-molar pregnancy, with normal serum bhcg ?
<1%
What are most complete moles diagnosed as?
Anembryonic or missed miscarriages
T/F Rise in urinary hcg after initial clinical response for choriocaecinoma is diagnostic of recurrence
F. Could be a new pregnancy
What percent of hydatiform moles are preceded by spontaneous/induced abortions and normal pregnancy
25% and 25%
5 year survival of choriocarcinoma with optimal treatment?
95%
Chemotherapy rate for partial vd complete mole?
13-16% complete
0.5 to 1% partial
Incidence of GTD?
Which individuals are at increased risk?
1 in 714 live births
Increased risk in:
- Asians
- extremes of age (<15, >50yrs)
T/F Choricarinoma responds to folic acid antagonists?
True
Single agent/ IM methotrexate therapy is used for low risk patients and has a cure rate of 100%.
Low risk = score of 6 or less according to the FIGO classification system for GTN
Treatment for GTN?
According to FIGO scoring system for GTN.
Score of 6 or less = low risk
IM Methotrexate only
- Cure rate: 100%
Score of 7 or more = high risk
Combo of:
Methotrexate, Dactinomycin, Etoposide, Cyclophosohamide, Vincristine
- Cure rate: 94%
Risk of GTN in a subsequent pregnancy event in women who have NOT received chemo for a prior molar pregnancy?
1 in 4011
(VERY LOW RISK)
- Hence bhcg measurements after any subsequent pregnancy event is not necessary
Optimum f/u after complete mole?
Bhcg w/in 56 days of pregnancy:
- if normal f/u 6 months after uterine evacuation
- if not normal, f/u 6 months after normalization of bhcg levels
Optimum f/u after partial mole?
F/u stops when hcg is NORMAL on 2 samples take 4 weeks apart
Should all miscarriages be examined histologically?
Yes. ALL material should be sent to pathology
Because GTD can be difficult to recognize at the time of miscarriage
Alternative if products of conception post miscarriage were not sent for histopathology?
Pregnancy test 3 weeks post miscarriage.
If positive, refer to GTD center
Same applies to medical abortion!!
Should all surgical abortions be examined histologically?
Yes if fetal parts were not seen on
u/s or at time of surgical abortion.
No if fetal parts seen on u/s or at time of abortion
