GTD Flashcards
1
Q
What is GTD
A
- Partial or comple mole
- Invasive mole
- Choriocarcinoma
- Rare placental site trophoblastic tumour and epithelioid tumour
2
Q
Complete mole
A
- Diploid
- 1 sperm fertilize empty oocyte (80%) or
2 sperms w empty oocyte (20%)
3
Q
Partial mole
A
- Triploid
- 2 sperms + 1 egg
- 69 XXY or 69 XYY
4
Q
GTD incidence
A
1:714
Inc risk if age <15 or >50
5
Q
GTN definition
A
- Persistent rise of HCG after birth/treatment for GTD
6
Q
Signs of GTD
A
- Irregular vaginal bleeding (in 60% cases)
- +PT
- High HCG
- HG/ severe NVP
- USS evidence of GTD
7
Q
USS features
A
Complete mole
- Polypoid mass 5-7w
- Thickened cycstic app of villious tissue
- No gest sac
Partial mole
- Enlarged placenta
- Cystic changes in the decidua
- Empty sac/ late miscarriage signs
8
Q
Diagnosis of mole
A
- Histology
- Complete- No fetal tissue
- Extensice hydropic changes to villi
- Excess trophoblast proliferation
- Partial- Fetal tissue
- Focal hydropic changes
- Some excess trophoblastic changes
9
Q
Staining to check for parital vs complete mole
A
p57 staining
10
Q
Mx of ?mole
A
- EVAC under USS
- Higher rate of incomplete removal/ risk of GTN w medical mx
11
Q
EVAC for mole advise
A
- Try not to use oxytocins unless heavy bleeding
- Give anti D
- Anti D not req for complete mole, but unable to tell till histology is back
12
Q
Repeat treatment
A
- only if it is life saving
- If not, discuss w GTD centre
13
Q
F/u
A
Weekly HCG
Complete mole
- If normal in 56 days, the f/u in 6months from EVAC.
- If NOT normal in 56 days, then f/u 6 months from normal level.
Partial mole
- F/u completed once HCG normal on 2 samples 4 weeks apart
14
Q
Referral to GTD centre
A
- Diagnosed mole
- High HCG after 2x methotrexate
- Persistent heavy bleeding after preg event
- PSTT or ETT or PSN
15
Q
Twin preg w molar preg
A
- Refer to GTD
- Consider karotyping of twin
- Inc risk of perinatal loss/GTN
