[Tropho] Hydatidiform Moles

Question 1

Risk Factors for H. Mole

Answer 1

1. Maternal Age
2. Paternal Age
3. Previous H. Mole
4. Race (Asians have an increased incidence of H. Mole)
5. Diet and Nutrition
   - Decreased dietary carotene

Question 2

Clinical Presentation of Complete H. Mole

Answer 2

1. Amenorrhea
2. Positive PT
3. Vaginal Bleeding (89-97%)
4. Uterus enlarged greater than AOG (40%)
5. Absence of FHT
6. Theca Lutein Cysts (20%)
7. Hyperemesis (15-25%)
8. Pre-eclampsia (12-27%)
9. Hyperthyroidism (2-7%)
10. Respiratory Insufficiency (2%)

Question 3

This is the most accurate non-invasive imaging modality for H Moles

Answer 3

Pelvic Ultrasound

Question 4

Clinical Presentation of Partial H. Mole

Answer 4

No prominent clinical features

Diagnosis is made based off histologic examination of curettage specimens

Question 5

2 Significant Ultrasonographic Findings in PHM

Answer 5

1. Focal cystic changes in the placenta

2. Ratio of the transverse to AP dimension of the gestational sac >1.5

Question 6

This is used when histologic diagnosis is in doubt (CHM vs PHM vs non-molar gestations)

Answer 6

Immunostaining with p57kip2

Question 7

The Immunostain p57kip2 is positive in these kinds of H. Moles

Answer 7

Partial H. Moles and Hydropic Abortions

Question 8

Most common clinical presentation of H. Moles

Answer 8

Vaginal Bleeding

Question 9

Preferred management for patients desirous of future pregnancy

Answer 9

Suction Curettage

Question 10

What cervical ripening agents should be used when managing H. Moles?

Answer 10

Mechanical dilators such as laminaria tents or balloon catheters are used

Prostanoids are avoided to reduce the risk of pulmonary embolization and dissemination of trophoblastic cells

Question 11

Risk of Malignancy after a Complete H. Mole

Answer 11

15-25%

Question 12

Risk of Malignancy after a Partial H. Mole

Answer 12

0.5-4%

Question 13

Risk Factors for Postmolar Trophoblastic Disease

Answer 13

1. Advanced maternal age >/= 40
2. Uterine size > 6 weeks AOG
3. Serum bHCG Titers >/= 100,000 mIU/mL
4. Theca Lutein Cysts >/= 6cm
5. Presence of any medical complications associated with increased trophoblastic proliferation (PE, Thyrotoxicosis, PI, DIC)
6. Recurrent H Moles
7. Documented H. Mole with a coexisting normal twin

Question 14

When is Chemoprophylaxis given in GTDs?

Answer 14

Patients who are at high risk for postmolar GTD

Question 15

What therapeutic agents are given for chemoprophylaxis of GTDs?

Answer 15

Methotrexate

Actinomycin D

Question 16

First line agent for chemoprophylaxis of GTD

Answer 16

Methotrexate, IM

Question 17

Contraindications to Chemoprophylaxis

Answer 17

1. Hemoglobin <100mg/dL, Hct <0.30
2. WBC Count <3x10^9
3. ANC = 1.5
4. Platelet Count <100
5. Any active infection
6. Presence of liver/renal dysfunction

Question 18

Normal level of serum B-hCG

Answer 18

5 miU/mL

Question 19

How do you measure B-hCG after molar evacuation?

Answer 19

One week after molar evacuation and then once every two weeks until normal