Management of Gestational Trophoblastic Disease Flashcards
What is the best method for removal of a molar pregnancy?
Suction curettage
Should pregnancy tissue be sent for examination after abortion?
No need to routinely send pregnancy tissue for histological examination following therapeutic abortion, provided that fetal parts have been identified at the time of surgicalabortion or on prior ultrasound examination
A urine hCG test should be performed in all cases of persistent or irregular vaginal bleedinglasting more than ___ weeks after a pregnancy event.
A urine hCG test should be performed in all cases of persistent or irregular vaginal bleedinglasting more than 8 weeks after a pregnancy event.
For complete molar pregnancy, if hCG has reverted to normal within __ days of the pregnancyevent then follow-up will be for _ months from the date of uterine removal.
For complete molar pregnancy, if hCG has reverted to normal within 56 days of the pregnancy event then follow-up will be for 6 months from the date of uterine removal.
When does follow up for partial molar pregnancy conclude?
Follow-up for partial molar pregnancy is concluded once the hCG has returned to normal on two samples, at least 4 weeks apart.
What is the difference between Gestational trophoblastic disease (GTD) and gestational trophoblastic neoplasia (GTN?
Gestational trophoblastic disease (GTD) comprises a group of disorders spanning the premalignant conditions ofcomplete and partial molar pregnancies (also known as hydatidiform moles) through to the malignant conditions ofinvasive mole, choriocarcinoma and the very rare placental site trophoblastic tumour (PSTT) and epithelioidtrophoblastic tumour (ETT). If there is any evidence of persistence of GTD after primary treatment, most commonly defined as a persistent elevation of human chorionic gonadotrophin (hCG), the condition is referred to as gestational trophoblasticneoplasia (GTN)
What is the incidence of gestational trophoblastic disease in the Uk?
1 in 714 live births
What is the incidence of GTD in the UK for women from Asia?
1 in 387 live births
What is the incidence of GTD in the UK for women NOT from Asia?
1 in 752 live births
What is the incidence of GTD in women aged <15 years?
1 in 500 pregnancies
What is the incidence of GTD in women aged >50years
1 in 8 pregnancies
What is the incidence of GTN after a live birth?
1 in 50000
What is the most common presenting symptom of molar pregnancy?
Vaginal bleeding remains the most common presenting symptom of molar pregnancy and is associatedwith approximately 60% of presentations.
When pregnancy tissue was routinelyexamined after surgical removal, the incidence of molar pregnancy and atypical PSNs, unrecognised prior to removal, was ___%
2.7%
What are pathological features consistent with the diagnosis of complete molar pregnancies?
Absence of fetal tissue; extensive hydropic change to the villi; excess trophoblast proliferation
What are pathological features consistent with the diagnosis of complete molar pregnancies?
presence of fetal tissue; focal hydropic change to the villi; and some excess trophoblast proliferation.
How can you distinguish partial from complete molar pregnancies histologically?
Ploidy status and immunohistochemistry staining for p57-is a protein product of a paternally imprinted gene (CDKN1C) that is normally expressed from the maternal allele.
- complete mole (CM) shows absent staining whereas hydropic abortus (HA) and partial mole (PM) show positive staining.
Is Anti D needed to be given after surgical removal of molar pregnancy?
Not needed for complete molar pregnancies; It is required for partial molar pregnancies;
Poor vascularisation of the chorionic villi and absence of the D antigen by trophoblast cells means thatanti-D prophylaxis is not required for complete molar pregnancies.
There is a higher rate of incomplete removal with medical methods. The risk of this increasing the need for treatment for GTN is ____% with complete molar pregnancies and _____% with partial molar pregnancies
13-16% with complete molar pregnancies and 0.5-1% with partial molar pregnancies
What is the risk of GTN developing after confirmed therapeutic abortion?
1 in 20000
What rare reasons can cause raised hCG levels ?
- familial raised hCG (10-200)
- malignant female germ cell tumours
- epithelial cancers- bladder, breast, lung, gastric, colorectal coancers
- pituitary hCG
- presence of human anti0mouse antibodies
What is the risk of choriocarcinoma occurring after miscarriage/therapeutic abortion / term pregnancy?
1 in 50,000 pregnancies
How common is it to develop GTN within 8 weeks after removal of a molar pregnancy, with a normal hCG urine to serum level ?
uncommon <1%
What is the risk of early fetal loss in a twin pregnancy of a viable foetus and coexisting molar pregnancy?
An increased risk of 40%
What is the risk of premature birth in a twin pregnancy of a viable foetus and coexisting molar pregnancy?
36%
What is the risk of recurrence after 1 previous molar pregnancy?
2%
What is the risk of recurrence after 2 moles?
20%
What is the prevalence of complete molar pregnancies?
1 in 1000 pregnancies
What is the prevalence of partial molar pregnancies?
3 in 1000 pregnancies
A viable twin can develop alongside a CHM or PHM in 1:______ pregnancies
1:20,000-100,000
Ultrasound is poorly predictive of a molar pregnancy diagnosis, with accuracy rates of only ____%.
40-60%
The risk of developing GTN is __ times higher in medical evacuation of complete molar pregnancies compared to surgical evacuation.
The risk of developing GTN is 16 times higher in medical evacuation of complete molar pregnancies compared to surgical evacuation.
For complete molar pregnancy, if the hCG has reverted to normal within ___ days of the pregnancy, then the follow-up is for____after the surgical evacuation.
56 days; 6 months
If the hCG has not reverted to normal within 56 days of the pregnancy event, how should the woman be followed up after a CHM?
the follow-up is for 6 months from the normalisation of hCG.
Choriocarcinoma may complicate 1 in __ 000 pregnancies and one in__ of hydatidiform moles.
Choriocarcinoma may complicate 1 in 50 000 pregnancies and one in 40 (3%) of hydatidiform moles.
About __% of hydatidiform moles may progress to become invasive moles.
10%
By clinical presentation, __% of invasive moles demonstrate metastases to the lung and vagina.
15
