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MRCOG - Part 2 > GTD > Flashcards

GTD Flashcards

1
Q

Incidence of GTN after therapeutic abrotion

A

1 in 20000

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2
Q

Classic features of Molar Pregnancy

A
  1. Irregular Vaginal Bleeding
  2. Hyperemesis
  3. Execessive Uterine Enlargement
  4. Early failed Pregnancy

Rarely:
- Hypothyroidism
- early onset PE
- Abd. distension d.t. theca lectin cyst

Very rare:
- Acute rep. failure
-Neuro: seizures d.t. metastasis

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3
Q

U/S of complete mole

A

5-7 w: polypoid mass
>8 w: thickened cystic appearance of the villous tissue w/o GSac

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4
Q

Soft markers on U/S of partial mole

A

Cystic Spaces in placenta
Ratio of transverse to AP dimension of Gsac is >1.5

resemble anembryonic preg. or delayed missed abortion.

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5
Q

Is US and clinical diagnosis confirmatory

A

No.
Histopathology is confirmatory

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6
Q

Should tissues be sent after all miscarriages to histo.

A

Only if the fetal tissue wasn’t identified at any stage of pregnancy.
Or if not sent, can ask her to do urine pregnancy. test after 3 weeks.

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7
Q

Should tissue be sent to histo after therapeutic abortion?

A

Not req. if fetal parts are identified & do a UPT after 3 weeks

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8
Q

How many cases of GTD are unrecognized prior to removal?

A

2.7%

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9
Q

TTT of choice for Complete and partial mole

A

Suction curetage under US guidance.

In Partial Mole if fetal parts doesn’t allow suction-> medical evacuation

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10
Q

Risk of developing GTN, if medical management used compared to surgical management

A

16 times

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11
Q

Risk of requiring chemo for GTN post complete mole or partial mole?

A

Complete: 13-16%
Partial: 0.5-1%

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12
Q

Can prior Cx preparation done?

A

Yes

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13
Q

Can oxytocin infusion be used prior to completion of removal

A

No, fear of risk of embolism.

only used in severe Haemorrhage

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14
Q

When is a repeat surgery indicated

A

If acute hemodynamic compromise d.t. persistent bleeding w/ retained products on US –> repeat surgery

repeat surgery shouldn’t be done w/o referral to GTD center.

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15
Q

Where are GTD centers?

A

LONDON
DUNDEE
SHEFFIELD

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16
Q

Should Anti-D be given

A

In partial mole : Yes
In Complete mole: No d.t. poor vascularization of chorionic villi and no anti-D

If no histopathology available, given to all patients

17
Q

How do you follow up post partial mole pregnancy

A

Stop F/up once bhCG is normal on 2 samples 4 weeks apart.

18
Q

How do you follow up post complete mole pregnancy

A

If bhCG normalizes within 56 days or 8 weeks-> f/up for 6 month since evacuation

If bhCG normalizes after 8 weeks or 56 days -> f/up for 6 months since normalization

19
Q

Incidence of GTD if chemo not required in previous preg

A

1 in 4011

20
Q

should you investigate for GTN after all non molar preg

A

NO
Only if vaginal bleeding persistent >8 w after pregnancy event-> do UPT

If -ve –> <1% risk of GTN

21
Q

Histopath. of early complete molar ectopic pregnancy. is similar to

A

choriocarcinoma

22
Q

Complication of twin pregnancy, one viable & one molar

A

Early fetal loss
Preterm birth
PE

23
Q

MEMORIZE FIGO SCORING 2000

A
24
Q

How do u treat GTN

A

By scoring:
<6 Low risk: Single Agent IM MTX
>7 High risk: Multiple agent IV EMA CO

25
Q

What are EMA CO?

A
  • Etoposide
  • MTX
  • Dactinomycin
  • Cyclophosphamide
  • Vincristine
26
Q

Cure Rate of GTN

A

Low risk: MTX: 100%
High Risk: EMA CO: 95%

27
Q

when can women conceive after molar pregnancy.

A

Post molar: not before f/up is complete.
Post GTN: not before 1 year after complete chemotherapy

28
Q

Pregnancy rate if chemotherapy is given for GTN

A

80%

29
Q

Does chemo inc. risk of premature menopause

A

increased risk

30
Q

can estrogen & fertility drugs & HRT be used

A

yes, provided bhCG levels returned to normal

31
Q

Is PSTT & ETT chemo-sensitive?

A

No they are chem-resistant

32
Q

TTT of PSTT & ETT

A

Hysterectomy

33
Q

Most important prognostic factor in ttt of PSTT & ETT

A

Time of diagnosis from index pregnancy:
- If >4 years: 100% mortality
- If <4 years: Long term survival

MRCOG - Part 2 (44 decks)

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