Gestational trophoblastic disease Flashcards

1
Q

Types and Genetics

A
  1. Partial Mole
    - Triploid
    - 1 ovum fertilised by 2 sperm
    - US: Cystic spaces, often viable fetus until 8-9 weeks
    - Histology:Fetal tissue may be present, Focal villous oedema and hyperplasia, scalloped villi and villous inclusions
    - 2-5% risk of persistent GTN
  2. Complete Mole
    - Diploid: Paternal tissue only
    - Empty ovum fertilised by 2 sperm or 1 sperm divides
    - US: Multiple hypoechoic cysts filling endometrial cavity (‘snowstorm’ appearance)
    - Histology: No fetal tissue, Diffuse villous oedema and
    hyperplasia
    - 15-20% risk of perstistent GTN
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2
Q

Suggestive History features

A
  • Young or older patients
  • South East Asian descent
  • History of GTD
  • PV bleeding
  • Enlarged uteus
  • Hyperemesis
  • Hyperthyroid
  • Symptoms of early onset PET
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3
Q

Exam finding

A
  • General with vitals
  • Thyroid
  • Uterine palpation with enlarged size
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4
Q

Investigations to order

A

o Bloods
- bhCG
- FBE, UEC, LFTs
- Coags
- TSH
-Group and hold
* Cross match if uterine size >16/40
o Pelvic ultrasound
- May have characteristic ‘bunch of grapes’ or ‘snowstorm’ appearance but usually more subtle
- Fetus may be present in partial mole (usually demises at 8-9/40) but absent in complete mole
- Theca-lutein cysts
o CXR
- Depending on local protocols, some advise only if persistent GTD

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5
Q

Management

A
  1. Surgical
    - Nil misoprostol pre-op due to risk of trophoblastic embolisation
    - Suction currettage: Higher risk of perforation
    - Peformed under ultrasound guidance
    - Group and Hold pre op with cross match if Uterus >16 week size
    - oxytocin infusion post evacuation to reduce postpartum haemorrhage
    - Products for histology and genetic studies
  2. Post op:
    - Anti D if relevant
    - Refer to Molar Registry
  3. Document and debrief
  4. Follow up
    - Serial BHCG measurements according to local guidelines
    - General:
    Partial mole: Weekly until Negative
    Complete:
    - weekly until negative
    - monthly for 4 months
    - if more than >2 months to normalise: Monthly for 6 months after negative
  5. Contraception
    - reliable contraception NB and encouraged to avoid pregnant until complete follow up and 1 further period
  6. Advise re risk of Persistent GTD and Risk of recurrence
  7. Future pregnancy
    - Early ultrasound to exclude recurrence
    - Placenta for histology
    - BHCG 6/52 postpartum to ensure normalisation
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6
Q

Management of Peristent Mole

A
  • Single agent Chemotherapy most commonly with Methotrexate
  • Exlude Mets
  • Dose: 50mcg/m2 of body surface area or 1mg/kg
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