GESTATIONAL

TROPHOBLASTIC DISEASE

CASES FOR SMALL GROUP DISCUSSION

CASE 1: A 19-year-old G1, 10 weeks AOG, consults for vaginal bleeding. She has been experiencing severe
nausea and vomiting.
Physical examination:
BP- 130/80 mmHg ; CR – bpm ; FH – 16 cm ; no fetal heart tones appreciated
Speculum exam: (+) minimal bleeding per os
Internal exam: cervix soft, closed, uterus enlarged to 4 months size,

1. Give 3 differential diagnoses and the reason for considering these conditions.
2. What initial examinations should be requested to arrive at a diagnosis? Give the
expected results.
3. What are the other laboratory examinations to be requested?
4. What is the most appropriate method of evacuation?
5. Give the post-evacuation plan of management.

CASE 2: A 40-year-old, G5P4 (4014), consults for vaginal bleeding of 3 weeks duration. She had 4 normal
vaginal deliveries. Her last pregnancy a year ago was a Hydatidiform mole for which she underwent
suction curettage.
Physical examination:
BP- 120/80 mmHg ; CR – 80 bpm
Speculum exam: (+) minimal bleeding per os, On the left lateral vaginal wall is a 3 x 4 cm, soft , well
circumscribed mass, violaceous mass, non tender
IE: cervix patulous, uterus enlarged to 2 months size, with a cystic mass on the right adnexa measuring 6
x 7 cm, movable, non-tender.

1. What is the working diagnosis?
2. What initial laboratory examination should be requested to arrive at a diagnosis?
3. What is the stage of the disease?
4. What are the procedures / laboratory examinations to be requested?
5. What is the primary form of treatment?
6. A score of 10 was obtained using the WHO prognostic scoring. What form of
chemotherapy is appropriate?