Molar PG

Question 1

Gestational trophoblastic disease consists of

Answer 1

Spectrum of conditions
* Partial mole
* Complete mole
* Invasive or metastatic moles
* Choriocarcinoma
* Placental site trophoblastic disease
* Epithelioid trophoblastic tumor

Question 2

GTD

malignant gestational trophoblastic diseases types

Answer 2

• Choriocarcinoma
• Placental site trophoblastic tumor (PSTT)
• Epithelioid trophoblastic tumor

Question 3

GTD

Complete mole pathophysiology

Answer 3

Fertilization of an empty ovum by a sperm, then duplicates OR empty ovum if fertilized by 2 sperms

Question 4

GTD

Partial mole pathophysiology

Answer 4

Haploid ovum is fertilized by 2 sperms. 69 XXX, XXY, XYY

Question 5

GTD

Partial mole rare karyotype

Answer 5

XYY

Question 6

GTD

Complete mole consists of …. sets of paternal genes, maternal genes

Answer 6

2 sets of paternal genes
no maternal genes

Question 7

GTD

partial mole consists of …. sets of genes, maternal genes, paternal genes

Answer 7

3 sets of genes
1 maternal sets of genes
2 paternal sets of genes

Question 8

GTD

complete mole has…. fetus

Answer 8

no fetus

Question 9

GTD

Partial mole has….. fetus

Answer 9

non- viable fetus

Question 10

GTD

Fetal embryonic tissue is (present/ absent) in a complete mole

Answer 10

absent

Question 11

GTD

fetal embryonic tissue is (present/ absent) in complete mole

Answer 11

present - fetus, fetal RBC

Question 12

GTD

Trophoblastic hyperplasia is …. in complete mole

Answer 12

focal

Question 13

GTD

trophoblastic hyperplasia is….. in partial mole

Answer 13

diffuse

Question 14

GTD

Clinical presentation

Answer 14

• Irregular vaginal bleeding, some have passed vesicles
• Uterine size larger than date
• Early failed PG
• Hyperemesis
• Anemia
• Hyperthyroidism
• Early- onset severe pre- eclampsia
• thromboembolism
• large ovarian theca lutein cysts causing abnormal dilatation
• Neurological and respiratory Sx due to brain and lung metastasis

Question 15

GTD

Reason for hyperemesis

Answer 15

due to increased beta HCG

Question 16

GTD

Ix

Answer 16

• USS
• Histology
• hCG levels
• FBC - anemia
• LFT- uera, Sr. Cr, SE
• cross match blood, Rhesus factor
• Thyroid function
• CXR

Question 17

GTD

Why can LFT become abnormal

Answer 17

due to metastatic lesions in the liver

Question 18

GTD

USS findings of a complete mole

Answer 18

snow- storm appearance

Question 19

GTD

USS findings of partial mole

Answer 19

Difficult to detect
* Looking like a missed miscarriage
* Fetal parts seen

Question 20

GTD

Definitive Ix for molar PG

Answer 20

Histology

Question 21

GTD

beta HCG is done for

Answer 21

as a baseline for subsequent monitoring. Not considered to be a good diagnostic tool

Question 22

GTD

Mx of Molar PG

Answer 22

1. Evaluate potential medical complications ( anemia, hyperthyroidism)
2. Suction evacuation (under GA)

Question 23

GTD

optimal method of evacuation of the mole

Answer 23

suction evacuation under GA

Question 24

GTD

why is oxytocin not recommended prior to completion of evac

Answer 24

some case reports have shown that oxytocin causes metastatic lesions of molar PG

Question 25

# GTD Why is misprostol/ PGE2 not used in molar PG

Answer 25

medical induction and cervical priming by prostaglandin are not recommended

Question 26

# GTD Follow up should be done

Answer 26

for 6- 24 months

Question 27

# GTD what test should be done during follow- up

Answer 27

Sr/ urine hCG

Question 28

# GTD How often should hCG levels be tested

Answer 28

every 2 weekly until it is negative

Question 29

# GTD If hCG levels become normal within.... days, urine hCG will be checked.... for ..... months from the day of the.....

Answer 29

1. 56 days 2. monthly 3. 6 months 4. evac

Question 30

If hCG levels become normal after....... days, urine hCG will be checked.... for ..... months after the......

Answer 30

56 days monthly 6 months after the day the values become normal

Question 31

# GTD for how often should you use contraception after the suction evac

Answer 31

for at least 6 months after the hCG levels become normal

Question 32

# GTD the choice of contraception

Answer 32

barrier method

Question 33

# GTD Why is contraception essential after at least 6 months after hCG levels become normal

Answer 33

because raised hCG levels during the PG will make the monitoring difficult

Question 34

# GTD What is done if you get PG during the period where hCG levels are still high after the suction and evac

Answer 34

we allow the PG to continue. we do not terminate

Question 35

# GTD After hCG levels become normal what types of contraception is used

Answer 35

* COCP * POP * DMPA * IMP * Cu-IUCD * LNG- IUD