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Obstetrics > Mole Pregnancy - Mary > Flashcards

Mole Pregnancy - Mary Flashcards

1
Q

Gestational Trophoblastic Diseases that originate from the placenta

A

hydatiform mole, invasive mole, gestational choriocarcinomas, placental site trophblastic tumor

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2
Q

when is molar pregnancy usually diagnosed?

A

1st trimester

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3
Q

signs and symptoms of molar pregnancy

A 
abnormal bleeding (MC)
uterine enlargement 
absent fetal heart tones 
cystic enlargement of ovaries 
HEG 
abnormally high HCG 
gestational HTN/preeclampsia 
thyrotoxicosis
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4
Q

ultrasound findings of molar pregnancy

A

grape-like or snowstorm appearance

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5
Q

How will partial mole look on US?

A

may have fetal parts

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6
Q

risk factors for molar pregnancy

A

age (>45 and <20)
previous molar pregnancy
prior miscarriage
A or AB blood type

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7
Q

karyotype of partial mole vs complete mole

A

partial → 69 XXX or XXY

complete → 46 XX or XY

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8
Q

Pathology of partial mole

A 
may have fetal parts 
small placenta, small or normal size uterus 
normal bHCG 
rarely have medical complications 
rarely have postmolar malignant sequalae
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9
Q

How does partial mole usually present clinically?

A

as missed abortion

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10
Q

Pathology of complete mole

A

no fetal parts
large uterus
snowstorm of cysts on US
very high HCG
present with other sequelae (preeclam, thyrotoxic, HEG)
more likely to have postmolar malignant sequela

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11
Q

what is diagnosis of complete mole at clinical presentation?

A

molar pregnancy

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12
Q

15-25% of complete moles with clinically present with

A

theca lutein cysts

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13
Q

treatment for molar pregnancy

A

evacute with suction D&C

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14
Q

If you suspect your patients has mole what should you order prior to uterine evacuation?

A 
CBC 
Coag studies 
CMP 
type and screen
hCG levels 
PreOP chest x-ray 
TSH
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15
Q

alternative treatment to D&C in those who do not wish to preserve fertility → reduces risk of postmolar sequelae!

A

hysterectomy

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16
Q

How long do you monitor serial hCG postOP (D&C or hysterectomy) for molar pregnancy?

A

until value is 0

17
Q

when do most malignant sequelae occur after evacuation of mole?

A

within 6 months

18
Q

how do you monitor for malignant sequelae after evacuation?

A

serum hCG → within 48 hr postOP, every 1-2 wk while elevated, monthly for additional 6 months
pelvic exams → ensure involution of uterus and aid early dx of vaginal mets

19
Q

If your patient who had a normal term pregnancy has persistent abnormal bleeding for ______ you should order HCG testing?

A

> 6 weeks

20
Q

What should your patient be on while you are following their HCG after evacuation

A

contraceptive → OCP > barrier, IUD not recommended

21
Q

When can your patient d/c their contraceptive?

A

after documented remission for 6-12 months

22
Q

what is the recurrence rate of those with a history of hydatiform moles?

A

10 fold increased risk

23
Q

what is the criteria to diagnose postmolar gestational trophoblastic disease?

A

FIGO criteria

24
Q

What is the FIGO criteria for diagnosing postmolar GTD?

A
  1. HCG plateau of 4 values +/- 10% over 3 wk period
  2. HCG increases more than 10% of 3 values over 2 wk duration
  3. persistent detectable HCG for > 6 mo post molar evacuation
  4. presence of histologic choriocarcinoma
25
Q

risk of GTN after complete mole is ____ and after a partial mole is ____

A

15-20%

1-4%

26
Q

molar tissue grows into the myometrium

A

invasive mole

27
Q

trophoblastic tissue grows into the myometrium and blood supply and may metastasize

A

choriocarcinoma

28
Q

trophoblastic tissue at placental site grows into myometrium or beyond

A

placental site trophoblastic tumor

29
Q

FIGO Stage I

A

disease is confined to uterus

30
Q

FIGO Stage II

A

disease outside uterus but limited to genital structures

31
Q

FIGO Stage III

A

disease extends to lungs +/- genital tract involvement

32
Q

FIGO Stage IV

A

all other metastatic sites

33
Q

How does GTN spread? Most likely sites for metastasis?

A

hematogenous

lungs (80%) vagina (30%) liver and CNS (10%)

34
Q

treatment for stage I or low risk stage II or III

rate of remission?

A

single agent chemo with methotrexate or actinomycin D

80-85%

35
Q

treatment for high risk stage II or III

remision rate?

A

EMACO - etoposide, methotrexate/leucovorin, actinomycin-D, cyclophosphamide an vincristine (oncovin)
75-90%

36
Q

treatment for stage IV and remission rate?

A

EMACO + radiation + surgery

80%

37
Q

what is remission from GTN?

A

12 consecutive months of (-) bHCG and on contraceptive for 12 mo

Obstetrics (17 decks)

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