GTD

Question 1

GTD mx

Answer 1

• USS features - snowstorm (complete)
• USS features - fetal parts (partial)
• confirm with histological dx
• risk of GTN/progression to chorioca
• higher risk w complete mole
• ref tert - molar registry/GONC
• 3 options - D&E > med > expectant
• risk of latter 2 = bleed/no confirm
• MDI - gyn/ano +/- GONC
• USS guided D&E -> histo
  +/- anti-D

Postop mx
1. confirm histo
2. molar registry
3. bHCG tracking
- Partial - 3 consecutive then stop
- Complete - 3 consecutive then monthly for 6/12
4. contraception
5. monitor sx - pain/bleeding

Postop counselling
1. resume conception post surveillance
2. no impact on future fertility
3. early preg USS
4. recurrence low in future preg

Question 2

Mx of suspected GTN

Answer 2

• rise or plateau - ddx preg vs GTN
• MDI - gynae/GONC
• further ix - bloods/imaging - WHO
• WHO score dictates mx
• WHO score =<6 single agent (MTX+FA)
• WHO score >6 multi agent
• Good cure rate >90% w chemo
• No dmg to future fertility
• bHCG tracking for up to 12/12
• contraception during surveillance

Question 3

Mx of theca lutein cyst

Answer 3

• assoc with GTD but also OI
• risk of ovarian torsion
• conservative > lap drainage
• monitor for torsion sx
• repeat USS to check resolution