GTD

Question 1

U/s sensitivity of partial vs complete mole?

Answer 1

20% vs 95%

Question 2

U/s features of partial mole?

Answer 2

-Enlarged placenta/ cystic changes within decidua reaction (w/in placenta)
+
A viable fetus
- transverse anteroposterior diameter of the gestation sac >1.5 are suggestive

Question 3

Chance of a viable fetus if twin pregnancy with 1 molar pregnancy?

Answer 3

40%

Question 4

Risks associated. With a twin pregnancy with 1 molar pregnancy?

Answer 4

Increased risk of:

Early pregnancy loss 40%
Preterm birth 36%
Preeclampsia 20%

Question 5

T/F for twin pregnancy with a molar pregnancy
1. Increased risk of GTN
2. Affects outcomes of chemo
3. Increased need for chemo if pt delivers after 26weeks

Answer 5

1. F
2. F
3. F

Question 6

Risk of GTN after therapeutic abortion?

Answer 6

1 in 20,000

Question 7

Treatment for molar pregnancy (complete vs partial)?

Answer 7

Suction curettagebfor both

Can be done under u/s guidance:
Minimises risk of perforation
Removes as much tissue as possible

Question 8

Role of medical management in treatment?

Answer 8

If fetal size deters the use of suction
OR
With a twin gestation (and 1 molar preganancy), if the woman chooses to terminate or if IUD but rhe fetal size is too big

Question 9

Cons of using medical management?

Answer 9

1.Higher rates of incomplete removal, thereby increases the risk of GTN and chemotherapy by 16 fold (for complete moles)
2.Risk of embolization and dissemination of trophoblastic tissue in the venous system
- can lead to ARDS

Question 10

What percent of choricarcinoma were preceded by hydatidiform mole/molar pregnancy?

Answer 10

50%

2-3% of complete moles develop choriocarcinoma

Question 11

Risk of GTN 8wks after non-molar pregnancy, with normal serum bhcg ?

Answer 11

<1%

Question 12

What are most complete moles diagnosed as?

Answer 12

Anembryonic or missed miscarriages

Question 13

T/F Rise in urinary hcg after initial clinical response for choriocaecinoma is diagnostic of recurrence

Answer 13

F. Could be a new pregnancy

Question 14

What percent of hydatiform moles are preceded by spontaneous/induced abortions and normal pregnancy

Answer 14

25% and 25%

Question 15

5 year survival of choriocarcinoma with optimal treatment?

Answer 15

95%

Question 16

Chemotherapy rate for partial vd complete mole?

Answer 16

13-16% complete
0.5 to 1% partial

Question 17

Incidence of GTD?
Which individuals are at increased risk?

Answer 17

1 in 714 live births

Increased risk in:
- Asians
- extremes of age (<15, >50yrs)

Question 18

T/F Choricarinoma responds to folic acid antagonists?

Answer 18

True

Single agent/ IM methotrexate therapy is used for low risk patients and has a cure rate of 100%.

Low risk = score of 6 or less according to the FIGO classification system for GTN

Question 19

Treatment for GTN?

Answer 19

According to FIGO scoring system for GTN.

Score of 6 or less = low risk
IM Methotrexate only
- Cure rate: 100%

Score of 7 or more = high risk
Combo of:
Methotrexate, Dactinomycin, Etoposide, Cyclophosohamide, Vincristine
- Cure rate: 94%

Question 20

Risk of GTN in a subsequent pregnancy event in women who have NOT received chemo for a prior molar pregnancy?

Answer 20

1 in 4011
(VERY LOW RISK)

• Hence bhcg measurements after any subsequent pregnancy event is not necessary

Question 21

Optimum f/u after complete mole?

Answer 21

Bhcg w/in 56 days of pregnancy:

• if normal f/u 6 months after uterine evacuation
• if not normal, f/u 6 months after normalization of bhcg levels

Question 22

Optimum f/u after partial mole?

Answer 22

F/u stops when hcg is NORMAL on 2 samples take 4 weeks apart

Question 23

Should all miscarriages be examined histologically?

Answer 23

Yes. ALL material should be sent to pathology

Because GTD can be difficult to recognize at the time of miscarriage

Question 24

Alternative if products of conception post miscarriage were not sent for histopathology?

Answer 24

Pregnancy test 3 weeks post miscarriage.

If positive, refer to GTD center

Same applies to medical abortion!!

Question 25

Should all surgical abortions be examined histologically?

Answer 25

Yes if fetal parts were not seen on
u/s or at time of surgical abortion.

No if fetal parts seen on u/s or at time of abortion