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Trophoblastic Disease
Current management
Background
Incidence
Complete Mole
Pathology:
Karyotype:
90% 46XX
10% 46XY
Clinical:
Diagnosis:
Vaginal bleeding
95%
Enlarged uterus
50%
Theca lutein cysts 50%
Hyperemesis
25%
PET
25%
Hyperthyroidism
5%
Trophoblastic emboli 2%
Complete Mole
Partial Mole
Triploid karyotype extra haploid set paternal
Sometimes fetus present usually triploid
Pathology differs from complete:
Management
Pre-operative assessment medical complications / CXR
Evacuation -
Natural history:
Partial mole -
Follow up
Weekly -hCG (syncytiotrophoblast)
levels until
normal for 3 consecutive weeks
Can take 12-14 weeks
Then monthly until normal
for 6 months
Contraception:
Immediate
GTN Follow-up
0
<39
Mole
4
<3
Prognostic score
1
>39
Abortion
4-6
<4
3-4
Spleen
Kidney
1-4
Term pregnancy
7-12
<5
>5
5
GI tract
Brain
Liver
5-8
>8
Single drug
2 or more
ABO group deleted, Liver mets score upgraded, no medium risk group
Low risk = 6
High risk = 7
FIGO Staging
Stage 1
Stage 2
Stage 3
Stage 4
Chemotherapy
Low-risk
Methotrexate:
Many regimes
I.M. Methotrexate 1mg/Kg days 1,3,5,7
I.M./ P.O. Folinic acid 0.1mg/Kg days 2,4,6,8
I.M. Methotrexate 40mg/m weekly
Actinomycin D:
Follow-up:
Choriocarcinoma:
Treatment:
Prognosis:
Conclusions
GTN is rare
Ultrasound diagnosis becoming more common
Senior staff should perform ERPC ( suction and sharp curettage)
Follow-up clinical and serum -hCG measurements in specialized clinics
Chemotherapy curative in vast majority low risk patients