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Module 5 - GTD

Gestational Trophoblastic Disease

GTD definition pathologic proliferation of trophoblastic cells (outermost layer of embryonic cells)
Occurs in approx.________ 1 per 1500 live births
Risk factors Unknown
GTD includes_______ hydatiform mole, invasive mole and choriocarcinoma
S/S vaginal bleeding “prune juice” brownish, may be red, hyperemesis, absence of fetal heart tones and movement
uterine enlargement greater than expected for ________is a classic sign of a _______ ________ GA, COMPLETE mole
may have _________ hCG levels higher than norm
Treatment Suction evacuation – currettage of uterus to remove all fragments of placenta
If malignant GTD______ need for extensive follow up therapy, may need chemotherapy
Two types of molar pregnancy are_____ and _____ complete, partial
A complete mole develops from an ovum containing___________ (empty egg), which is fertilized by a _____ ______ no genetic material, a normal sperm. No embryonic tissues or membranes are found
A partial mole usually has a ___________ ________ (69 chromosomes) triploid karyotype
In a partial mole, most often a _____ ______ with 23 chromosomes, is fertilized by ____ ______ (dispermy) or by a sperm that has failed to undergo the first meiotic division and therefore contains 46 chromosomes normal ovum , two sperms
In a partial mole, there may be a fetal sac or even fetal heartbeat. The fetus has multiple anomalies because of the triplody and little chance for survival
Choriocarcinoma seems to be almost associated with the ______ _________ complete mole
Invasive mole is similar to a complete mole, but it invades the_________ myometrium
Serum hCG levels are ____ with molar pregnancy than normal pregnancy higher
If hydropic vesicles are passed, they are_______ diagnostic
Malignant GTD develops following evacuation of the mole in approx._______% of women 20
To detect malignancy early, all women with GTD should have extensive follow-up ________ therapy
Follow-up care includes a baseline_______ to detect metastasis and physical exam including a ______ exam chest x-ray, pelvic
hCG levels are monitored closely for a year; if there is any plateau or rise in hCG, _________and/or __________ is initiated methotrexate , chemotherapy
Assessment of GTD Brownish vaginal bleeding at @ 16 weeks * vomiting from elevated hCG * passing of grapelike vesicle * symptoms of PIH before 20 wks (hypertension, proteinuria)
Follow up care is ESSENTIAL. It includes baseline ____ ______, _______ levels and ______ exams for a year; Do not get pregnant for at least a year until cleared for choriocarcinoma (pregnancy will elevate hCG) chest x -ray, hCG, pelvic
Created by: CCBCMDNursing218