The commonality of all gestational trophoblastic diseases is that they secrete ________
BETA -- HCG
Which 2 gestational trophoblastic diseases can metastasize?
choriocarcinoma and invasive moles (though not a cancer)
What is the gold standard for diagnosing ectopic pregnancy? How will the results of a mole be different?
Ultrasound and B-HCG (1200), in a mole the B-HCG will be much higher
How do you get a complete mole and what is the karyotype?
fertilization of empty ovum by haploid sperm; 46 XX RARELY is it 46 xy
What is the usual way by which you get a partial mole? Karyotype?
2 sperm fertilize a NON empty ovum; 69 XXY, XXX, or XYY
Because you know you've wondered this since embyro day #1, where does the term hydatidiform mole come from?
mole from latin mola, refers to false conception/millstone and hydatisia is greek for a drop of water (chorionic villi are fluid filled) and it looks very similar to hydatid cysts in echinococcus infections. Now you know.
Which type of mole is often present with a co-existing fetus?
partial or incomplete mole
Name 2 cancers that can cross placenta
melanoma and choriocarcinoma
What disease represents the majority of patients who have elevated B-HCG AFTER molar evacuation
invasive mole, not choriocarcinoma
What is the main route of metastasis for choriocarcinoma?
There will be no test question on this tumor
placental site trophoblastic tumor, not gonna worry about it then! But the major problem is that it is insensitive to chemo
The frequency of gestational trophoblastic disease is highest in this country
Gestational trophoblastic disease tends to occur in areas with less of these 2 nutrients are consumed
beta carotene and folic acid
What should you do to the dose of folate in a pregant woman who has Hx of mole
increase the dose
What kind of age distribution occurs with moles?
bimodal (under 20, over 40)
Are moles benign or malignant?
benign (both are, complete and partial)
Complete moles have hyperplasia of this tissue
T/F: complete moles usually cause tremendous amounts of pain and mimic ectopic pregnancies
false, actually. They are surprisingly not associated with much pain
T/F: complete moles can mimic pre-ecclampsia
Why would you hear wheezing/rhonchi in a patient with a mole?
they can spread to the lungs
What is the Tx for a complete mole?
suction evacuation followed by sharp curretage; IV pitocin with follow up B HCGS
If the B HCG levels don?t decline after molar evacuation which 2 drugs can you use?
methotrexate (also DOC for ectopic pregnancy) and actinomycin D
At what age is hysterectomy for Tx of molar pregnancy appropriate?
What is the most common gynecologic cancer?
How awesome is Dr. Glines?
Which molar pregnancy is associated with a developing fetus?
T/F: partial moles are defined as a snow-storm pattern on ultrasound
false, complete moles are snow-storm patterns because the fluid filled cysts are very large and look like a snow storm
Path tie-in, the snowstorm pattern on ultrasound translates to a ____________ pattern on histology
coast of norway, again both are caused by the fact that there are large cystic spaces
What is a common way for partial moles to present?
they may present as a spontaneous or missed abortion
T/F most patients with partial moles have very large uterus for gestational age
false, this is true of complete moles but partial mole pts are small for dates
When will a partial mole patient become pre-ecclamptic in comparison to a complete mole patient?
usually one month later
Which patient is more likely to have wheezes and rhonchi, one with a complete or partial mole?
complete mole as it is more likely than a partial mole to metastasize
What is the work up of choriocarcinoma and why would you suspect this?
You suspect this after molar evacuation when there is elevated B HCG that is persistent, then you also do a CT of pretty much the whole body, also a lumbar puncture
How do you Tx choriocarcinoma with a good prognosis
actinomycin D and methotrexate
If choriocarcinoma is metastatic what is used in conjunction with medications?
Can a woman who has had choriocarcinoma get pregnant again?
she can but she SHOULD NOT AS SHE CAN DIE!
Can a woman who has had a molar evacuation get pregnant again?
yes 1 year later
Miscarraige is a is a lay term for ______
A spontaneous abortion that occurs AFTER 20 weeks but before 37 is deemed ___________
Intrauterine fetal demise
A spontaneous abortion that occurs BEFORE 20 weeks is called
a missed abortion
What is the frequency of abortions?
50% of pregnancies, they think that many women do not know they are pregnant
At what maternal age is the risk of spontaenous abortion higher?
30 but even higher at 35 and 40
Name the 7 types of abortions
threatened, inevitable, incomplete, complete, missed, therapeutic/elective, septic (any of the others PLUS infection)
Define threatened abortion
vaginal bleeding before the 20th week with a CLOSED CERVICAL OS
Define inevitable abortion
bleeding that occurs with the cervical os OPEN
Define incomplete abortion
vaginal bleeding with the os open and passage of some fetal tissue
Define complete abortion
bleeding with the os closed (??) and passage of all products of conception
Define missed abortion
fetus dies before 20 weeks and is retained in uterus
Define septic abortion
any abortion that occurs with infection
This is the term to describe 3 or more successive abortions
What kind of abortion occurs when there is vaginal bleeding without the passage of fetal tissue with an open cervical os?
What kind of abortion occurs before 20 weeks and the fetus is retained in the uterus?
What term describes when the fetus dies after 20 weeks of gestation and is retained in the uterus?
Intrauterine fetal demise
What term describes when there is vaginal bleeding prior to the 20th week with a closed cervical os?
What term describes when there is vaginal bleeding with an open cervical os and some passage of fetal tissue?
What term describes when a woman is 18 weeks pregnant, has a closed os and is bleeding and it is found that there is chorionitis due to ascending E. coli infection?
septic abortion (any abortion with an infection)
What is the most common cause of spontaneous abortion?
This bug can be harbored in the male prostate and causes spontaneous abortions
What is Asherman's syndrome?
When the lining of the cervix adheres to itself i.e. left side adheres to right side so there is obliteration of the uterine cavity
What is a BIG cause of uterine abnormalities?
D/C and scrapings
Name 3 important immunologic causes of abortion i.e. Rh and 2 others
Kell and Duffy antigens (Kell kills, Duffy dies)
How do you manage a threatened abortion?
ultrasound and rest and reassurance (just because bleeding doesn?t mean baby died but still called threatened "abortion")
How do you manage an inevitable abortion?
Admit the patient, analgesia, D/C etc.
How do you manage an incomplete abortion?
Admit the patient, analgesia, D/C etc. --same as inevitable
How do you manage a missed abortion?
D/C , cytotec, prostaglandins, laminaria
How do you manage a complete abortion?
supportive measures if necessary
How do you manage a septic abortion?
IV antibiotics and evacuation
How do you manage recurrent abortions?
start doing cultures and labs for antibodies such as Rh, duffy, kell, etc.
If a patient has any abortion and is Rh negative what do you give them?
What is Spalding's sign?
overlapping of fetal skull bones on X-ray due to liquefaction of the fetal brain
How do you ultimately Dx an abortion?
no fetal movement, no cardiac motion
How can you induce labor for someone with an abortion at 13-28 weeks? After 28 weeks? Why the difference?
13-28 weeks = prostaglandins; after 28 weeks = pitocin? The use of prostaglandins after 28 weeks is associated with a risk of uterine rupture