OBAb: Multifetal Pregnancy and GTD

Question 1

____ is in contact with the decidua basalis (fetal component) which comes from villous trophoblast. It transports nutrients

Answer 1

Chorion

Question 2

___ is composed of both syncitiotrophoblast (outer) and cytotrophoblast (inner)

Answer 2

trophoblast

Question 3

If the division occurs in <72 hours, the outcome would be?

Answer 3

Diamniotic, dichorionic

Remember, 72 day day, 4 day mon, 8 mon mon, late conj

Question 4

If the division occurs in the 4th to 8th day, the outcome would be?

Answer 4

Diamniotic, monochorionic

Remember, 72 day day, 4 day mon, 8 mon mon, late conj

Question 5

If the division occurs in more than 8 days, the outcome would be?

Answer 5

Monoamniotic, monichorionic

Remember, 72 day day, 4 day mon, 8 mon mon, late conj

Question 6

If the division occurs on a later day the outcome would be?

Answer 6

conjoined

Remember, 72 day day, 4 day mon, 8 mon mon, late conj

Question 7

[Complete or Partial Mole]

Empty ovum + paternal chromosome

Answer 7

Complete mole

Question 8

[Complete or Partial Mole]

1 maternal (23X)
2 paternal (23X, 23Y)

Answer 8

Partial mole

P(f)etal parts

Question 9

The focal swelling in H. mole is brought about by ____

Answer 9

paternal chromosomes

Question 10

[Complete or Partial Mole]

Uterine size small for dates
initial hCG <100,000
p57KIP2 positive

Answer 10

partial mole

Question 11

[Complete or Partial Mole]

molar gestation
uterine size large for gestational age
initial hCG >100,000
p57KIP2 negative

Answer 11

complete mole

Question 12

What is the most accurate non-invasive imaging modality in diagnosing H. mole

Answer 12

UTZ

Question 13

P57 kip2 is ___ imprinted but ____ expressed

maternally, paternally

Answer 13

Paternally imprinted

maternally expressed

Question 14

Position of the patient in doing suction curettage

Answer 14

Semi-fowler’s position

Question 15

Indications for chemoprophylaxis in patients with H. mole

Answer 15

1. Maternal age >/35
2. G4 and above
3. Uterine size larger than AOG >6 weeks
4. Serum hCG >/100,000
5. Theca lutein cysts >/6
6. Medical complication arising from increased trophoblastic proliferation
7. Repeat molar pregnancy
8. Residing in distant geographical location

Question 16

What is the monitoring schedule for H. mole patients?

Answer 16

1. 1 week after suction curettage
2. Every 2 weeks until hCG becomes normal for 3 consecutive tests
3. Every 1 month for first 6 months
4. Every 2 months for next 6 months

Question 17

What type of OCP will you use for patients s/p suction curettage for H. mole

Answer 17

Use low dose OCP

Avoid pregnancy during monitoring period

Question 18

When is pregnancy allowed in patients with H.mole

Answer 18

6 months AFTER normal hCG

Question 19

Patients with history of H. mole got pregnatn. What will be your workup?

Answer 19

1. Early UTZ
2. Chest or Cranial CT
3. Submit placenta for histopath
4. beta hCG done 6 weeks post partum

Question 20

GTN is defined as hCG values of ___

Answer 20

1. Plateau - increase or decrease of 10% of beta hCG for 3 determinations
2. Rise in beta-hcg for2 determinations
3. Persistently elevated hCG level for 6 months or more
4. Presence of metastatic disease
5. histologic diagnosis of choriocarcinoma

Question 21

[Staging of GTN]

Confined to the uterus

Answer 21

Stage I

Mgt: Single agent chemotherapy (Methotrexate or actinomycin) +/- Hysterectomy

Question 22

[Staging of GTN]

Extends outside uterus but confined to pelvic organs

Answer 22

Stage II

If Low risk, single agent chemo tx +/- hysterectomy

High risk: EMACO +/- Hysterectomy

Question 23

[Staging of GTN]

Pulmonary metastasis

Answer 23

Stage III
If Low risk, single agent chemo tx +/- hysterectomy

High risk: EMACO +/- Hysterectomy

Question 24

[Staging of GTN]

If metastasis to other sites present

Answer 24

1. EMACO

2. Hysterectomy or irradiation