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    Nita Corry Agustine
    Gestational trophoblastic disease includes hydatidiform mole, invasive mole, choriocarcinoma, and other rare forms. Complete hydatidiform moles occur more commonly in women under 21 or over 35. Southeast Asia has higher rates of molar pregnancies and choriocarcinoma than Western countries. Diagnosis involves ultrasound, serum hCG levels, and pathology. Treatment of molar pregnancies involves evacuation followed by serial hCG monitoring to detect persistent trophoblastic disease requiring chemotherapy. Long term follow up is needed due to the risk of recurrence.

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    Gestational trophoblastic disease includes hydatidiform mole, invasive mole, choriocarcinoma, and other rare forms. Complete hydatidiform moles occur more commonly in women under 21 or over 35. Southeast Asia has higher rates of molar pregnancies and choriocarcinoma than Western countries. Diagnosis involves ultrasound, serum hCG levels, and pathology. Treatment of molar pregnancies involves evacuation followed by serial hCG monitoring to detect persistent trophoblastic disease requiring chemotherapy. Long term follow up is needed due to the risk of recurrence.

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    Gestational trophoblastic disease includes hydatidiform mole, invasive mole, choriocarcinoma, and other rare forms. Complete hydatidiform moles occur more commonly in women under 21 or over 35. Southeast Asia has higher rates of molar pregnancies and choriocarcinoma than Western countries. Diagnosis involves ultrasound, serum hCG levels, and pathology. Treatment of molar pregnancies involves evacuation followed by serial hCG monitoring to detect persistent trophoblastic disease requiring chemotherapy. Long term follow up is needed due to the risk of recurrence.

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    Download as PPT, PDF, TXT or read online from Scribd
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    27 views16 pages

    Untitled 1

    Uploaded by

    Nita Corry Agustine
    Gestational trophoblastic disease includes hydatidiform mole, invasive mole, choriocarcinoma, and other rare forms. Complete hydatidiform moles occur more commonly in women under 21 or over 35. Southeast Asia has higher rates of molar pregnancies and choriocarcinoma than Western countries. Diagnosis involves ultrasound, serum hCG levels, and pathology. Treatment of molar pregnancies involves evacuation followed by serial hCG monitoring to detect persistent trophoblastic disease requiring chemotherapy. Long term follow up is needed due to the risk of recurrence.

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    GESTATIONAL TROPHOBLASTIC DISEASE I:

    EPIDEMIOLOGY, PATHOLOGY, CLINICAL


    PRESENTATION AND DIAGNOSIS OF GESTATIONAL
    TROPHOBLASTIC DISEASE, AND MANAGEMENT OF
    HYDATIDIFORM MOLE

    Presented by :
    Nita Corry Agustine Nias Waruwu

    Facilitated by :
    Dr. Maruarar Panjaitan, SpOG
    Introduction

    Gestational trophoblastic disease includes hydatidiform mole


    and gestational trophoblastic neoplasia (invasive mole,
    choriocarcinoma, placental site trophoblastic tumor,
    and epithelioid trophoblastic tumor).
    Particular emphasis is given to management of hydatidiform
    mole, including evacuation, twin mole/normal fetus
    pregnancy, prophylactic chemotherapy, and follow-up.
    Epidemiology
    North America, Australia, New Zealand, & Europe → incidence of
    hydatidiform mole to range from 0.57–1.1 per 1000 pregnancies.
    Southeast Asia and Japan → an incidence as high as 2.0 per 1000
    pregnancies.
    Europe & North America, choriocarcinoma → 1 in 40,000 pregnancies & 1 in
    40 hydatidiform moles. Southeast Asia & Japan choriocarcinoma rates are
    higher at 9.2 and 3.3 per 40,000 pregnancies, respectively.
    Women aged 21-35 years, the risk of complete mole is 1.9 times higher for
    women both 35 years & 21 years as well as 7.5 times higher for women 40
    years.
    There also seems to be an increased risk of choriocarcinoma in women with
    long-term oral contraceptive use and blood group A.
    Pathology

    Normal trophoblast is composed of :



    Cytotrophoblast

    Syncytiotrophoblast

    Intermediate trophoblast

    All 3 types of trophoblast result in GTD when they proliferate.


    Clinical Presentation
    Complete hydatidiform mole :
     Vaginal bleeding (80-90%)

    Uterine enlargement (28%)

    Hyperemesis (8%)

    Pregnancy-induced hypertension (1%)

    USG : bilateral theca lutein cyst enlargement (15%), fetal heart (-).

    Lab : hCG levels > 100,000 mIU/mL

    Partial mole :
    Irregular bleeding

    Enlarged, irregular uterus

    Persistent bilateral ovarian enlargement

    Pulmonary symptoms

    serum hCG levels are only slightly elevated

    Gestational trophoblastic neoplasia :


    Incomplete or missed abortion

    Vaginal bleeding (75%)

    Excessive uterine enlargement

    Hyperemesis, pregnancy-induced hypertension, hyperthyroidism

    USG : theca lutein cysts develop infrequently

    Lab : hCG levels > 100,000 mIU/mL (<10%)


    Diagnosis

    Ultrasonography : hCG serum :


    plays a critical role in the easily measured
    diagnosis of both quantitatively in both
    complete and partial urine and blood, hCG levels
    mole, and it has virtually have been shown to
    replaced all other means correlate with the burden
    of preoperative diagnosis. of disease.
    Diagnosis

    Pathologic diagnosis :
    Pathologic diagnosis of complete and partial moles is
    made by examination of curettage specimens.
    Additionally, pathologic diagnosis of invasive mole,
    choriocarcinoma, PSTT, and ETT can sometimes be
    made by curettage, biopsy of metastatic lesions, or
    examination of hysterectomy specimens or placentas.
    Hydatidiform mole : Treatment
    Diagnosis of molar pregnancy :
    – History, physical examination, hCG levels, and ultrasound findings.
    – Evaluation of medical complications → vital signs & laboratory
    tests.
    – Preoperative evaluation →blood type & crossmatch, serum hCG ,
    ECG.

    The diagnosis is confirmed and the patient is determined to be


    hemodynamically stable, the most appropriate method of molar
    evacuation should be decided upon.
    Prophylactic administration of either methotrexate or actinomycin D
    chemotherapy → have to be limited.
    Follow-up after molar evacuation
    Follow-up after evacuation of a hydatidiform mole → detect trophoblastic
    sequelae (invasive mole or choriocarcinoma) → develop in approximately
    15-20% with complete mole and 1-5% with partial mole.
    Serial serum quantitative hCG measurements every 1-2 weeks until 3
    consecutive tests show normal levels, after which hCG levels →
    determined at 3-month intervals (6 months) after the spontaneous return
    to normal.
    Contraception → 6 months after the first normal hCG result.
    Pathologic examination of the placenta and other products of conception as
    well as determination of a 6-week postpartum hCG level is recommended
    with all future pregnancies.
    THANK YOU

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