Molar Pregnancy - William Flashcards
What is on the spectrum of gestational trophoblastic disease?
Hydatiform mole (complete and partial), invasive mole, Gestational choriocarcinomas, placental site trophoblastic tumors
Where does gestational trophoblastic disease originate?
The placenta
When is molar pregnancy usually diagnosed?
in the 1st trimester
What are some S&S of molar pregnancy?
abnormal bleeding, uterine enlargement, absent fetal heart tones, cystic enlargement of the ovaries (Theca Lutein cysts), Hyperemesis Gravidarum, HIGH hCG, pregnancy induced HTN/pre-eclampsia, thyrotoxicosis
U/S finding for molar pregnancy?
grape-like appearance or snowstorm. May see fetal parts if the molar pregnancy is a partial pregnancy
What are the risk factors for a molar pregnancy?
Age (<20 or >45), prior miscarriage, prior molar pregnancy, blood types A or B
What is the usual inheritance pattern for a complete mole?
46XX, all paternally derived (Homozygous complete mole).
What is the least common inheritance pattern for a complete mole?
46XY
What are some characteristics of a complete mole?
no fetal parts, uterus size greater than fates, snowstorm appearance, grossly elevated bhCG
What sequalae is a complete mole more likely to present with?
pre-eclampsia, thyrotoxicosis, hyperemesis, postmolar malignancy
What is the usual inheritance pattern for a partial mole?
69XXX or 69 XXY
What are some characteristics of a partial mole?
small fetal parts, small placenta, small or normal uterine size for dates, normal bhcg, medical complications are rare, postmolar malignancies are rare
What is the treatment for a molar pregnancy?
suction D&C, or hysterectomy if they don’t wish to preserve fertility
What are the studies that need to happen if a mole is suspected?
CBC, Coag study, CMP, Type and Screen, hCG level, Pre-op chest X-ray, TSH
When do most post-molar sequalae occur?
within 6 months of evacuation
Post evacuation of a mole, what must be monitored?
serum hCG: within 48 hrs. of evacuation, every 1-2 weeks while elevated, then every 6 months after that
Do you perform pelvic exams post evacuation of a mole?
yes to ensure involution of the uterus and early dx of vaginal metastasis
Anyone with persistent abnormal bleeding for 6 months post evacuation should have what?
hCG testing
Why is contraception needed post evacuation?
so that pregnancy does not occur which can obscure post-evac hCG monitoring
When can contraception be discontinued?
after documented remission for 6-12 months
What is the 1st FIGO criteria for postmolar gestational trophoblastic disease?
hCG plateau of 4 values +/- 10% over a 3 wk. period (days 1, 7, 14, 21)
What is the 2nd FIGO criteria for postmolar gestational trophoblastic disease?
hCG levels increase of more than 10% of 3 values over a 2 wk. duration (days 1, 7, 14)
What is the 3rd FIGO criteria for postmolar gestational trophoblastic disease?
persistence of detectable hCG for more than 6 months after molar evacuation
what is the 4th FIGO criteria for postmolar gestational trophoblastic disease?
presence of histologic choriocarcinoma
What are the gestational trophoblastic neoplasia’s (GTN)?
invasive mole, choriocarcinoma, and placental site trophoblastic tumor
What is an invasive mole?
Molar tissue growing into the myometrium
What is a choriocarcinoma?
trophoblastic tissue growing into the myometrium and the blood supply to metastasize
What is a placental site trophoblastic tumor?
trophoblastic tissue at the placental site growing into myometrium or beyond
What is the FIGO stage I?
disease is confined to the uterus?
What is the FIGO stage II?
The disease is outside of the uterus but limited to the genital structures
What is the FIGO stage III?
lung invasion with or without genital tract involvement
That is the FIGO stage IV?
all other metastatic sites
What is the most likely place of metastasis?
lungs
What can you treat a FIGO stage I or low risk stage II/III with?
single agent chemo with methotrexate or actinomycin-D
What can you treat a high risk FIGO stage II/III with?
combo therapy with Etoposide, Methotrexate/Leucovorin, Actinomycin-D, Cyclophosphamide, Oncovin/Vincristine (EMACO)
What can you treat FIGO stage IV with?
combo chemo with EMACO, radiation, and surgery
When is GTN considered to be in remission?
after 12 consecutive months of negative bhCG levels. Effective contraception for 12 months
