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gestational trophoblastic disease (complications (massive bleeding: anemia…
gestational trophoblastic disease
investigations
USG
incomplete mole
v fetus
complete mole
x fetus v snowstorm appearance, multiple hypoechogenic cystic structure
uterus large for date
HCG & pregnancy test
complete mole
(positive when super dilution or blood test) super high HCG, PT-ve
incomplete mole
okay high HCG, PT+-ve
others
CBC (anemia), LFTRFT (baseline for methotrexate), thyroid function test (rule out hyperemesis gravidarum), cross-match, CXR (metastasis)
diagnosis
histology
beta HCG decrease and no residual trophoblastic disase
history
(nausea/vomiting, weight loss) hyperemesis gravidarum
pass vesicular tissue
vaginal bleeding
physical examination
management
(no methotrexate: embolization!) suction evacuation, with synctocinon (uncontrolled bleeding: hysterectomy)
monitor HCG until decrease to normal, monitor every week, 6-8 weeks after delivery (residual trophoblastic disease)
HCG plateau: chemotherapy
HCG normal v oral contraception, oral conception for 1 year
management
(no chemo: embolization!) suction (uncontrolled bleeding: hysterectomy)
incomplete mole
definition
trophoblast: neoplasm
malignant
invasive mole, choriocarcinoma, placenta site trophoblastic tumour
benign
hydatiform mole/molar pregnancy (complete mole, partial mole)
metastasis
complete mole (empty ovum, sperm duplication)
(empty ovum, dipsermic fertilization)
(46XX, 46X) diploid
higher chance malignant
incomplete mole (normal ovum, dispermic fertilization)
triploid (69XXY, 69XXX, 69XYY)
lower chance malignant
complications
massive bleeding: anemia
uterine perforation
pelvic sepsis
high HCG, hyperthyroidism
residual trophoblastic disease
pre-eclampsia
DIC