Mole Pregnancy - Mary Flashcards
Gestational Trophoblastic Diseases that originate from the placenta
hydatiform mole, invasive mole, gestational choriocarcinomas, placental site trophblastic tumor
when is molar pregnancy usually diagnosed?
1st trimester
signs and symptoms of molar pregnancy
abnormal bleeding (MC) uterine enlargement absent fetal heart tones cystic enlargement of ovaries HEG abnormally high HCG gestational HTN/preeclampsia thyrotoxicosis
ultrasound findings of molar pregnancy
grape-like or snowstorm appearance
How will partial mole look on US?
may have fetal parts
risk factors for molar pregnancy
age (>45 and <20)
previous molar pregnancy
prior miscarriage
A or AB blood type
karyotype of partial mole vs complete mole
partial → 69 XXX or XXY
complete → 46 XX or XY
Pathology of partial mole
may have fetal parts small placenta, small or normal size uterus normal bHCG rarely have medical complications rarely have postmolar malignant sequalae
How does partial mole usually present clinically?
as missed abortion
Pathology of complete mole
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
what is diagnosis of complete mole at clinical presentation?
molar pregnancy
15-25% of complete moles with clinically present with
theca lutein cysts
treatment for molar pregnancy
evacute with suction D&C
If you suspect your patients has mole what should you order prior to uterine evacuation?
CBC Coag studies CMP type and screen hCG levels PreOP chest x-ray TSH
alternative treatment to D&C in those who do not wish to preserve fertility → reduces risk of postmolar sequelae!
hysterectomy
How long do you monitor serial hCG postOP (D&C or hysterectomy) for molar pregnancy?
until value is 0
when do most malignant sequelae occur after evacuation of mole?
within 6 months
how do you monitor for malignant sequelae after evacuation?
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
If your patient who had a normal term pregnancy has persistent abnormal bleeding for ______ you should order HCG testing?
> 6 weeks
What should your patient be on while you are following their HCG after evacuation
contraceptive → OCP > barrier, IUD not recommended
When can your patient d/c their contraceptive?
after documented remission for 6-12 months
what is the recurrence rate of those with a history of hydatiform moles?
10 fold increased risk
what is the criteria to diagnose postmolar gestational trophoblastic disease?
FIGO criteria
What is the FIGO criteria for diagnosing postmolar GTD?
- HCG plateau of 4 values +/- 10% over 3 wk period
- HCG increases more than 10% of 3 values over 2 wk duration
- persistent detectable HCG for > 6 mo post molar evacuation
- presence of histologic choriocarcinoma
risk of GTN after complete mole is ____ and after a partial mole is ____
15-20%
1-4%
molar tissue grows into the myometrium
invasive mole
trophoblastic tissue grows into the myometrium and blood supply and may metastasize
choriocarcinoma
trophoblastic tissue at placental site grows into myometrium or beyond
placental site trophoblastic tumor
FIGO Stage I
disease is confined to uterus
FIGO Stage II
disease outside uterus but limited to genital structures
FIGO Stage III
disease extends to lungs +/- genital tract involvement
FIGO Stage IV
all other metastatic sites
How does GTN spread? Most likely sites for metastasis?
hematogenous
lungs (80%) vagina (30%) liver and CNS (10%)
treatment for stage I or low risk stage II or III
rate of remission?
single agent chemo with methotrexate or actinomycin D
80-85%
treatment for high risk stage II or III
remision rate?
EMACO - etoposide, methotrexate/leucovorin, actinomycin-D, cyclophosphamide an vincristine (oncovin)
75-90%
treatment for stage IV and remission rate?
EMACO + radiation + surgery
80%
what is remission from GTN?
12 consecutive months of (-) bHCG and on contraceptive for 12 mo
