Gestational Trophoblastic Disease abnormal proliferation and then

degeneration of the trophoblastic villi.

- In in every 1500 pregnancies.
- Choriocarcinoma rapidly metasizing malignancy
Risk factors:
Women who have low protein intake
Older than 35 years old.
Younger than 18 years old
Women of Asian heritage.
Type of Molar Growth
1. Complete Mole all trophoblastic villi well and become cystic
- If embryo forms, it dies early at only 1-2 mm in size, no fetal blood
- Karyotype: normal 46XX or 46 XY from dads chromosomes x2, empty
ovum
- Leads to choriocarcinoma
2. Partial Mole the syncytiotrophoblastic layer is swollen and misshapen
- Macerated embryo of approximately 9 wks may be present and fetal blood
may be present in the villi.
- Karyotype: 69 chromosomes (a triploid formation in w/c there are three
chromosomes instead of 2 for every pair)
- Rarely leads to choriocarcinoma
Diagnostic tests:
Urine test: hCG (1-2 million IU, normal: 400,000 IU)
UTZ: dense growth (snowflake pattern) but no fetal growth
Signs and Symptoms
Uterus expand faster than normal before the usual time (over the symphysis
brim at 12 wks, at the umbilicus 20-24 wks)
n/v
no fetal heart sounds
symptoms of PIH: htn, edema, proteinuria before 20 wks
vaginal bleeding at 16 wks (vaginal spotting of dark brown blood or as a
profuse fresh flow)
bleeding accompanied by discharge of the clear fluid-filled vesicles
Therapeutic Management:
D&C
Monitor hCG 3 times after surgery (every 2 weeks)
- Half of women still have a positive reading at 3 wks, women still positive at
40 days
Baseline pelvic examination, chest xray, and a serum test for the beta
subunit of hCG (every 4 wks for 6-12 mos)
oral contraceptives for 12 mos
methotrexate, dactinomycin if metastasis occurs