Molar PG Flashcards
OBS
Gestational trophoblastic disease consists of
Spectrum of conditions
* Partial mole
* Complete mole
* Invasive or metastatic moles
* Choriocarcinoma
* Placental site trophoblastic disease
* Epithelioid trophoblastic tumor
GTD
malignant gestational trophoblastic diseases types
- Choriocarcinoma
- Placental site trophoblastic tumor (PSTT)
- Epithelioid trophoblastic tumor
GTD
Complete mole pathophysiology
Fertilization of an empty ovum by a sperm, then duplicates OR empty ovum if fertilized by 2 sperms
GTD
Partial mole pathophysiology
Haploid ovum is fertilized by 2 sperms. 69 XXX, XXY, XYY
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Partial mole rare karyotype
XYY
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Complete mole consists of …. sets of paternal genes, maternal genes
2 sets of paternal genes
no maternal genes
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partial mole consists of …. sets of genes, maternal genes, paternal genes
3 sets of genes
1 maternal sets of genes
2 paternal sets of genes
GTD
complete mole has…. fetus
no fetus
GTD
Partial mole has….. fetus
non- viable fetus
GTD
Fetal embryonic tissue is (present/ absent) in a complete mole
absent
GTD
fetal embryonic tissue is (present/ absent) in complete mole
present - fetus, fetal RBC
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Trophoblastic hyperplasia is …. in complete mole
focal
GTD
trophoblastic hyperplasia is….. in partial mole
diffuse
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Clinical presentation
- Irregular vaginal bleeding, some have passed vesicles
- Uterine size larger than date
- Early failed PG
- Hyperemesis
- Anemia
- Hyperthyroidism
- Early- onset severe pre- eclampsia
- thromboembolism
- large ovarian theca lutein cysts causing abnormal dilatation
- Neurological and respiratory Sx due to brain and lung metastasis
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Reason for hyperemesis
due to increased beta HCG
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Ix
- USS
- Histology
- hCG levels
- FBC - anemia
- LFT- uera, Sr. Cr, SE
- cross match blood, Rhesus factor
- Thyroid function
- CXR
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Why can LFT become abnormal
due to metastatic lesions in the liver
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USS findings of a complete mole
snow- storm appearance
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USS findings of partial mole
Difficult to detect
* Looking like a missed miscarriage
* Fetal parts seen
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Definitive Ix for molar PG
Histology
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beta HCG is done for
as a baseline for subsequent monitoring. Not considered to be a good diagnostic tool
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Mx of Molar PG
- Evaluate potential medical complications ( anemia, hyperthyroidism)
- Suction evacuation (under GA)
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optimal method of evacuation of the mole
suction evacuation under GA
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why is oxytocin not recommended prior to completion of evac
some case reports have shown that oxytocin causes metastatic lesions of molar PG
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Why is misprostol/ PGE2 not used in molar PG
medical induction and cervical priming by prostaglandin are not recommended
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Follow up should be done
for 6- 24 months
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what test should be done during follow- up
Sr/ urine hCG
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How often should hCG levels be tested
every 2 weekly until it is negative
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If hCG levels become normal within…. days, urine hCG will be checked…. for ….. months from the day of the…..
- 56 days
- monthly
- 6 months
- evac
If hCG levels become normal after……. days, urine hCG will be checked…. for ….. months after the……
56 days
monthly
6 months
after the day the values become normal
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for how often should you use contraception after the suction evac
for at least 6 months after the hCG levels become normal
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the choice of contraception
barrier method
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Why is contraception essential after at least 6 months after hCG levels become normal
because raised hCG levels during the PG will make the monitoring difficult
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What is done if you get PG during the period where hCG levels are still high after the suction and evac
we allow the PG to continue. we do not terminate
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After hCG levels become normal what types of contraception is used
- COCP
- POP
- DMPA
- IMP
- Cu-IUCD
- LNG- IUD
