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Obstetrics > Molar Pregnancy - William > Flashcards

Molar Pregnancy - William Flashcards

1
Q

What is on the spectrum of gestational trophoblastic disease?

A

Hydatiform mole (complete and partial), invasive mole, Gestational choriocarcinomas, placental site trophoblastic tumors

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2
Q

Where does gestational trophoblastic disease originate?

A

The placenta

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3
Q

When is molar pregnancy usually diagnosed?

A

in the 1st trimester

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4
Q

What are some S&S of molar pregnancy?

A

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

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5
Q

U/S finding for molar pregnancy?

A

grape-like appearance or snowstorm. May see fetal parts if the molar pregnancy is a partial pregnancy

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6
Q

What are the risk factors for a molar pregnancy?

A

Age (<20 or >45), prior miscarriage, prior molar pregnancy, blood types A or B

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7
Q

What is the usual inheritance pattern for a complete mole?

A

46XX, all paternally derived (Homozygous complete mole).

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8
Q

What is the least common inheritance pattern for a complete mole?

A

46XY

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9
Q

What are some characteristics of a complete mole?

A

no fetal parts, uterus size greater than fates, snowstorm appearance, grossly elevated bhCG

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10
Q

What sequalae is a complete mole more likely to present with?

A

pre-eclampsia, thyrotoxicosis, hyperemesis, postmolar malignancy

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11
Q

What is the usual inheritance pattern for a partial mole?

A

69XXX or 69 XXY

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12
Q

What are some characteristics of a partial mole?

A

small fetal parts, small placenta, small or normal uterine size for dates, normal bhcg, medical complications are rare, postmolar malignancies are rare

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13
Q

What is the treatment for a molar pregnancy?

A

suction D&C, or hysterectomy if they don’t wish to preserve fertility

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14
Q

What are the studies that need to happen if a mole is suspected?

A

CBC, Coag study, CMP, Type and Screen, hCG level, Pre-op chest X-ray, TSH

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15
Q

When do most post-molar sequalae occur?

A

within 6 months of evacuation

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16
Q

Post evacuation of a mole, what must be monitored?

A

serum hCG: within 48 hrs. of evacuation, every 1-2 weeks while elevated, then every 6 months after that

17
Q

Do you perform pelvic exams post evacuation of a mole?

A

yes to ensure involution of the uterus and early dx of vaginal metastasis

18
Q

Anyone with persistent abnormal bleeding for 6 months post evacuation should have what?

A

hCG testing

19
Q

Why is contraception needed post evacuation?

A

so that pregnancy does not occur which can obscure post-evac hCG monitoring

20
Q

When can contraception be discontinued?

A

after documented remission for 6-12 months

21
Q

What is the 1st FIGO criteria for postmolar gestational trophoblastic disease?

A

hCG plateau of 4 values +/- 10% over a 3 wk. period (days 1, 7, 14, 21)

22
Q

What is the 2nd FIGO criteria for postmolar gestational trophoblastic disease?

A

hCG levels increase of more than 10% of 3 values over a 2 wk. duration (days 1, 7, 14)

23
Q

What is the 3rd FIGO criteria for postmolar gestational trophoblastic disease?

A

persistence of detectable hCG for more than 6 months after molar evacuation

24
Q

what is the 4th FIGO criteria for postmolar gestational trophoblastic disease?

A

presence of histologic choriocarcinoma

25
Q

What are the gestational trophoblastic neoplasia’s (GTN)?

A

invasive mole, choriocarcinoma, and placental site trophoblastic tumor

26
Q

What is an invasive mole?

A

Molar tissue growing into the myometrium

27
Q

What is a choriocarcinoma?

A

trophoblastic tissue growing into the myometrium and the blood supply to metastasize

28
Q

What is a placental site trophoblastic tumor?

A

trophoblastic tissue at the placental site growing into myometrium or beyond

29
Q

What is the FIGO stage I?

A

disease is confined to the uterus?

30
Q

What is the FIGO stage II?

A

The disease is outside of the uterus but limited to the genital structures

31
Q

What is the FIGO stage III?

A

lung invasion with or without genital tract involvement

32
Q

That is the FIGO stage IV?

A

all other metastatic sites

33
Q

What is the most likely place of metastasis?

A

lungs

34
Q

What can you treat a FIGO stage I or low risk stage II/III with?

A

single agent chemo with methotrexate or actinomycin-D

35
Q

What can you treat a high risk FIGO stage II/III with?

A

combo therapy with Etoposide, Methotrexate/Leucovorin, Actinomycin-D, Cyclophosphamide, Oncovin/Vincristine (EMACO)

36
Q

What can you treat FIGO stage IV with?

A

combo chemo with EMACO, radiation, and surgery

37
Q

When is GTN considered to be in remission?

A

after 12 consecutive months of negative bhCG levels. Effective contraception for 12 months

Obstetrics (17 decks)

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