GTD

Question 1

GTD consists of

Answer 1

Hydatidiform mole (partial and complete)
Invasive mole
Choriocarcinoma
Placental site trophoblastic tumour
Epithelioid trophoblastic tumour
Atypical placental site nodule

Question 2

Complete molar pregnancies are

Answer 2

46XX
Anucleic ovum fusing with one sperm (85%) or with two sperm (15%)

Question 3

Partial molar pregnancies are

Answer 3

Triploid (90%) or tetraploid/mosaic (10%)

Question 4

Incidence of GTD

Answer 4

1 in 714 births

Question 5

Incidence of GTN after live birth

Answer 5

1 in 50000

Question 6

Cure rate in U.K.

Answer 6

98-100%

Question 7

Chemotherapy rate after partial molar pregnancy

Answer 7

0.5-1%

Question 8

Chemotherapy rate after complete molar pregnancy

Answer 8

13-16%

Question 9

Recurrence risk after 1 molar pregnancy

Answer 9

1 in 80

80% same histological type

Question 10

Recurrence risk after 2 molar pregnancies

Answer 10

1 in 6.5

80% same histological type

Question 11

Choriocarcinoma metsastatic sites

Answer 11

Lungs (cannon ball mets)
Kidneys
Spleen
GI tract
Brain
Liver

Question 12

Signs of GTD

Answer 12

Irregular vaginal bleeding
Positive UPT
Sonographic appearance
Enlarged uterus
Hyperemesis
Hyperthyroidism
Early onset PET
Abdominal distension with theca lutein cysts
Haemoptysis
Seizures

Question 13

Oxytocin is safe?

Answer 13

Not recommended

Question 14

Cervical preparation prior to SEVAC is safe?

Answer 14

Yes

Question 15

Follow up for complete mole

Answer 15

6 months if HCG normalises within 56 days
OR
6 months from normalisation of HCG

Question 16

Follow up for partial mole

Answer 16

Concluded on normal HCG x 2 4 weeks apart

Question 17

Avoid pregnancy for how long after chemotherapy?

Answer 17

1 year

Early conception associated with stillbirth, LGA and abortion in some studies (not definitive)

Question 18

Treatment for placental site trophoblastic tumours (PSTT) and epithelioid trophoblastic tumours (ETT)

Answer 18

Hysterectomy
Does not respond to chemotherapy

Question 19

Pregnancy rate after chemotherapy?

Answer 19

80%

Question 20

IUD Contraception safety

Answer 20

MEC 1 if HCG is undetectable

MEC 3 if decreasing HCG

MEC4 if HCG persistently elevated or malignant disease

Question 21

Progesterone contraception safety

Answer 21

MEC 1

Question 22

COCP safety

Answer 22

MEC 1

Question 23

Treatment for FIGO score 6 or less

Answer 23

Methotrexate for 1 week alternating daily with folinic acid then 6 days rest

Question 24

Treatment for FIGO score 7 or above

Answer 24

Multi-agent with:
Methotrexate
Dactinomycin
Etoposide
Cyclophosphamide
Vincristine

Continue until 6 after normalised HCG

Question 25

FIGO 2000 scoring criterion

Answer 25

Age Antecedent pregnancy Months from index pregnancy to Rx Pretreatment serum HCG Largest tumour size (cm) Size of mets Number of mets Previous failed chemotherapy

Question 26

Twin pregnancy with viable fetus and co-existing molar pregnancy management

Answer 26

Counsel about risks Invasive testing for karyotype

Question 27

Twin pregnancy outcomes

Answer 27

Early fetal loss 40% Preterm birth 36% PET 20% No affect on outcome after chemo