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Gestational trophoblastic disease (GTD) (Pathophysiology (Premalignant…
Gestational trophoblastic
disease (GTD)
Definition
Spectrum of premalignant
and malignant disorders due
to overgrowth of the placenta
Epidemiology
Rare; <1% pregnancies
Pathophysiology
Premalignant hydatiform mole or
malignant choriocarcinoma and
placental site trophoblastic tumour
50% follow a mole, 25% miscarriage/ectopic,
and 25% a normal pregnancy
More paternal than maternal DNA
I.e. partial molar (two sperm, empty egg)
Full molar (triploidy; two sperm in normal egg)
Diagnosis
Investigations
Bedside
Obs (BP, HR, RR, sats, temp)
Bloods
FBC, U+E, LFT, clotting,
group and save, crossmatch
Hormones: progesterone, B-hCG (may be high)
Imaging
USS: snowstorm
CXR: mets
CT chest/abdo/pelvis: staging
Examination
Pelvic
Masses, tenderness, bleeding
Speculum
Blood in vagina, masses, POC
Abdominal
Masses
History
PGH
Menses, bleeding, contraception,
STIs, smears
POH
Gravity/parity, ectopics/moles/miscarriages,
conception, delivery, gestation, complications
Current pregnancy
Gestation, scans, symptoms, general health
PMH
Known chronic diseases,
abdo/pelvic surgery
HPC/PC
PV bleeding, pain, passage of products,
abdo/pelvic masses, weight loss, fatigue
FH
GTD, gynae disorders, cancers
SH
Occupation, social support,
alcohol, smoking
Clinical
presentation
Systemic symptoms
Weight loss
Fatigue
Symptoms of organ mets e.g. lung
Gynae symptoms
Irregular PV bleeding
Passage of POC
Abdominal pain
Masses (abdo, PV)
Management
Medical: chemotherapy
Indication: mole (failed surgical), choriocarcinoma
MOA: methotrexate-based therapy to destroy tissue
SEs: mucositis, pancytopenia, neutropenic sepsis,
N+V, diarrhoea, teratogenicity (do not concieve <6m)
Conservative
Identify cause
Information, advice, support
Surgical: evacuation
Indication: 1L mole
MOA: physical removal of mole
SEs: bleeding, infection, uterine perforation,
damage to nearby structures, failed surgery