gestational trophoblastic disorders

what are gestational trophoblastic disorders?

spectrum of disorders originating from the placental trophoblast

what are the 3 types of gestational trophoblastic disorders?

- complete hydatidiform mole

- partial hydatidiform mole

- choriocarcinoma

what is a complete hydatidiform mole?

empty egg is fertilized by a single sperm - and it duplicates its own DNA = 2 sets of paternal genes

what is a partial hydatidiform mole?

normal egg fertilised by 2 sperm mostly or 1 sperm that has extra set of chromosomes => 2 pairs of paternal chromosomes + 1 pair of maternal chromosomes

is a foetus made in complete mole?

no

is a foetus made in a partial mole?

yes but non-viable

what is the usual presentation for hydatidiform mole?

- bleeding in first trimester

- often presents as a threatened miscarriage

- uterus large for dates

- exaggerated symptoms of pregnancy e.g. hyperemesis

- very high hCG

- hypertension

- hyperthyroidism

- large ovarian cysts

how can it cause hyperthyroidsim?

hCG can mimic TSH and stimulate thyroid to produce excess T3 and T4

what would USS reveal?

- 'snow storm' appearance

- multiple hypoechoic cystic structure

what is the management for molar pregnancy?

- evacuation of uterus to remove the mole

- monitor hCG until return to normal

how do you confirm diagnosis?

tissue histology (after evacuation)

what are the potential complications of molar pregnancy?

metastasis

how long after are pts suffering from molar pregnancy followed up?

5 years - as high risk of cancer