Gestational Trophoblastic Disease

• following

  • abortion

  • ectopic pregnancy

  • full-term pregnancy

Hydatidiform mole

• villi become hydropic

• trophoblastic elements proliferate

• chorioadenoma destruens (invasive mole)

  • local invasion of myometrium by hydatidiform mole

• more common after pregnancies in very young (< 17 yr) or older (late 30s and 40s)

• partial mole

  • 1 maternal and 2 paternal chromosome sets

• complete mole

  • 2 paternal chromosome sets

Choriocarcinoma

• invasive,

• malignant trophoblastic cells

• usually widely metastatic tumour

• without hydropic villi

Epidemiology

• 1 in 2000 (USA) - 1 in 200 Asiatic countries

• 80% of hydatidiform moles benign and spontaneously regress

• 15 to 20% tend to persist

• 2 to 3% are followed by choriocarcinoma (in about 1 in 25,000 to 45,000 pregnancies).

Symptoms

• around 10-16 weeks after conception

• rapidly enlarging uterus, large for dates

• vaginal bleeding

• lack of foetal movement

• absent foetal heart sounds

• severe nausea and vomiting

• passage of grapelike molar tissue

Investigations

• USS

  • 'snowstorm' appearance

• beta-HCG

• CXR

Complications

• intrauterine infection

• septicaemia

• haemorrhage

• toxaemia

Treatment

• hydatidiform mole

  • if regresses

    • oral contraceptives for 6 months

  • evacuation by suction curette

    • + oxytocin stimulation

    • + curettage

  • ? hysterectomy

  • beta-hCG titre should fall in < 10 to 12 weeks

• choriocarcinoma (non-metastatic) - virtually 100% cure rate

  • chemotherapy

    • methotrexate

    • dactinomycin

  • hysterectomy

• choriocarcinoma (metastatic)- 60-80% cure rate

Recurrence

• 1%

• does not compromise fertility

• no increase increase in congenital anomalies, pregnancy wastage, or prenatal or perinatal complications.