short Lectutre

1. Gestational Trophoblastic
Disease
Rare complication of pregnancy (1:700) in which
abnormal trophoblastic proliferation occurs
• Benign hydatidiform mole
• Partial Mole
• Highly invasive tumour – Choriocarcinoma
•Signs: a uterus filled with abnormal placental tissue
and absence of fetus

2. Molar pregnancy (Snowstorm)

3. Molar Tissue

4. Gestational trophoblastic neoplasia
• Complete mole
– Diploid
– Androgenetic
– Duplication of paternal chromosomes following
fertilsation of ‘empty’ ovum
– No fetus
• Partial Mole
– Triploid
– 2 sets paternal chromosomes, one set maternal
– Dispermic fertilisation of single ovum
– Fetus present

5. GTN
• Diagnosis
• Clinical features
– Bleeding, hyperemesis, early onset
preeclampsia
• USS finding
• Biochemistry – high HCG

6. Management
• Surgical evacuation
• Registration National
• Serial HCG monitoring
– 6-24 months
– Blood initially
– Urine
– After each subsequent pregnancy

7. Persistent GTN and
(choriocarcinoma)
• Can occur after live birth (1:50000) and
after any pregnancy
• 15% need chemotherapy after complete
mole
• 0.5% need chemotherapy after partial
mole
• Chemotherapy:
– Methotrexate 1st line
• Cure rates 98-100%

8. Further Management
• Future Pregnancy
– Advise to wait until HCG normal for 6 months
– Urine test after
• Contraception
– Barrier
– OCP may be used once HCG normal
• Recurrence rate
– 1:55

9. Many Thanks