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Molar Pregnancy Gestational Trophoblastic Disease - Coggle Diagram
Molar Pregnancy
Gestational Trophoblastic Disease
Definition
Pregnancy that has not developed normally from beginning
Characterised by trophoblastic tissue that proliferates more aggressively than is usual and secretes excess HCG
Classification
Gestational Trophoblastic Disease
Molar Pregnancy
(Hydatidifom Mole)
Complete
Trophoblastic tissue with no embryonic / fetal parts
Partial
Trophoblastic tissue with non viable embryonic / fetal parts
Parts → partial
Gestational Trophoblastic Neoplasia (GTN)
(Malignant)
Invasive Mole
Choriocarinoma
Placental site trophoblastic tumour
Epidemiology
Incidence
1 /700 pregnancy that end in a live birth - rare
Prognosis
98-100% cure rate with follow up and treatment
Low recurrence rate <1%
Causes
Imbalance in number of chromosomes from mother and father
Can not develop into a healthy pregnancy
Complete Molar Pregnancy
Empty ovum + 1 sperm duplicayes
Diploid (46n)
Paternal only
Empty ovum + 2 sperm
Diploid (46n)
Paternal only
Partial Molar Pregnancy
Ovum + 2 sperm
Triploid (6n)
Paternal and maternal
Risk Factors
Extremes of reproductive age
Asian
Complications
Excess HCG
Hypermesis gravidarum
Hyperthyroidim (mimis TSH)
Early onset severe pre-eclampsia
Neoplastic development
Metastatic disease
Respiratory
Neurological
Death
Assessment
Presentation
Irregular or heavy vaginal bleeding in early pregnancy
Abdominal distension
Excessive uterine enlargement
Theca-lutein ovarian cysts (due to HCG)
Severe hyperemesis gravidarum
Hyperthyroidism
Early onset pre-eclampsia
Failed early pregnancy
Investigations
Diagnosis
By histopathology only following ERCP
Ploiy studies / P57 staining may assist
TVUS
Snowstorm appearance in complete molar pregnancy
Echogenic mass (trophoblastic tissue)
Role of TVUS limited in partial molar pregnancy - may only show empty sac
β HCG levels
Very high
Management
Surgical Evacuation of Retained Products of Conception
ERPC
Experienced opertator - risk of significant blood loss
Suction aspiration
Avoid oxytocin - risk of trophoblastic embolism
Serial β-HCG
Follow - Up
Screen for development of GTN using HCG level
Follow until HCG normalised for partial pregnancy or
Follow up at least 6 months after surgery for complete molar pregnancy
Patient must avoid pregnnacy
Avoid IUCD until HCG level returns to normal
Perform HCG level after every future pregnancy
Councelling
The problem with genetic make-up of pregnancy from beginning
Early placental tissue has developed but not properly and the baby hasn't developed
The pregnancy is not health and will not develop into a healthy pregnancy
Gestational Trophoblastic Neoplasia
Epidemiology
Usually diagnosed furing follow up of molar pregnancy when HCG levels don't normalise
15% complete molar pregnancies require chemo
0.5% partial molar pregnancies require chemo
Causes
Molar pregnancy (complete / partial)
Miscarriage
Postpartum
Presentation
Persistent vaginal bleeding
Respiratory / neurological symptoms from mets
Prognosis
Almost 100% cure rate
Death if undiagnosed
Treament
Chemotherapy
Low risk pt
Single agent chemotherapy - Methotrexate
High risk pt
Multi agent / combination chemotheray
Duration
Until HCG level return to normal for 6 weeks
Councelling