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gynecology_gestational trophoblastic disease (complications (massive…
gynecology_gestational trophoblastic disease
physical examination
complete mole
empty ovum, sperm duplication/dispermic fertilization
higher chance malignant
diploid (46XX)
history
vaginal bleeding
pass vesicular tissue
(nausea/vomiting, weight loss) hyperemesis gravidarum
management
suction evacuation (uncontrolled bleeding: hysterectomy)
every week. HCG until normal
every month, 6 months (residual trophoblastic disease)
before HCG normal x oral contraception x IUCD after normal 1 year oral contraception
histology says malignant HCG suboptimal falls, increase, plateau (3 consecutive times)
(systemic treatment) methotrexate
future pregnancy
after delivery 6-8 weeks monitor HCG
investigations
others
CBC (anemia), LFTRFT (baseline for methotrexate), TFT (if hyperemesis gravidarum rule out) cross-match, CXR (metastasis)
diagnosis
histology from suction evacuation
bHCG, pregnancy test
super high HCG, pregnancy test -ve
diagnosis
afterwards HCG falls to normal, no residual trophoblastic disease
USG
snowstorm appearance, multiple hypoechogenic cystic structures
x fetus
uterus large for date
physical examination
management
suction evacuation (uncontrolled bleeding: hysterectomy)
every week, HCG until normal
every month, 6 months (residual trophoblastic disease)
before normal x oral contraception x IUCD after normal 1 year oral contraception
histology says malignant HCG suboptimal falls, increase, plateau (3 consecutive times)
methotrexate (systemic treatment)
future pregnancy
after delivery 6-8 weeks monitor HCG
investigations
others
CBC (anemia), LFTRFT (baseline for methotrexate), TFT (if hyperemesis gravidarum rule out) cross-match, CXR (metastasis)
diagnosis
histology from suction evacuation
bHCG, pregnancy test
okay high HCG, pregnancy test -ve/+ve
diagnosis
HCG falls to normal, no residual trophoblastic disease
USG
no
v fetus
uterus large for date
incomplete mole
normal ovum, dispermic fertilization
lower chance malignant
triploid (69XXY)
history
vaginal bleeding
pass vesicular tissue
hyperemesis gravidarum (nausea/vomiting, weight loss)
definition
trophoblast: neoplasm
malignant
invasive mole
choriocarcinoma
placenta site trophoblastic tumour
benign
hydatiform mole/molar pregnancy (complete/incomplete mole)
complications
massive bleeding
uterine perforation
pelvic sepsis
high HCG, hyperthyroidism
residual trophoblastic disease
pre-eclampsia
disseminated intravascular coagulation