Gestational Trophoblastic Disease
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| GTD definition | pathologic proliferation of trophoblastic cells (outermost layer of embryonic cells)
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| Occurs in approx.________ | 1 per 1500 live births
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| Risk factors | Unknown
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| GTD includes_______ | hydatiform mole, invasive mole and choriocarcinoma
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| S/S | vaginal bleeding “prune juice” brownish, may be red, hyperemesis, absence of fetal heart tones and movement
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| uterine enlargement greater than expected for ________is a classic sign of a _______ ________ | GA, COMPLETE mole
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| may have _________ hCG levels | higher than norm
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| Treatment | Suction evacuation – currettage of uterus to remove all fragments of placenta
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| If malignant GTD______ | need for extensive follow up therapy, may need chemotherapy
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| Two types of molar pregnancy are_____ and _____ | complete, partial
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| 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
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| A partial mole usually has a ___________ ________ (69 chromosomes) | triploid karyotype
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| 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
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| 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
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| Choriocarcinoma seems to be almost associated with the ______ _________ | complete mole
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| Invasive mole is similar to a complete mole, but it invades the_________ | myometrium
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| Serum hCG levels are ____ with molar pregnancy than normal pregnancy | higher
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| If hydropic vesicles are passed, they are_______ | diagnostic
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| Malignant GTD develops following evacuation of the mole in approx._______% of women | 20
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| To detect malignancy early, all women with GTD should have extensive follow-up ________ | therapy
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| Follow-up care includes a baseline_______ to detect metastasis and physical exam including a ______ exam | chest x-ray, pelvic
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| hCG levels are monitored closely for a year; if there is any plateau or rise in hCG, _________and/or __________ is initiated | methotrexate , chemotherapy
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| 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)
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| 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
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