Gestational trophoblastic disease

Published on 09/03/2015 by admin

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Last modified 09/03/2015

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Chapter 25 Gestational trophoblastic disease

Gestational trophoblastic diseases are disorders in which the normal regulatory mechanisms controlling the behaviour of trophoblastic tissue are lost.

Incidence. Incidence is 1 in 1400 pregnancies.

Hydatidiform mole

Risk factors

• varying between populations

• dietary factors

• maternal age >35 years (complete mole)

• previous molar pregnancy

Partial hydatidiform mole

Chromosomes

• It involves a triploid karyotype, paternal 46XX/XY and maternal 23X (i.e. a normal egg with dispermy).

• If maternal 46XX and paternal 23X or 23Y, the result is a triploid fetus.

• Thus, placental growth is dependent on paternal genetic material.

Pathology

• chorionic villi of varying size with focal hydatidiform swelling, cavitation and trophoblastic hyperplasia

• marked villous scalloping, prominent stromal trophoblastic inclusions

• identifiable fetal tissues

Presentation

• most diagnosed on ultrasound scan

• vaginal bleeding, hyperemesis

• uterus large for dates, theca lutein cysts

• pre-eclampsia, hyperthyroidism

Investigations

• full blood count, blood group and cross-match, quantitative human chorionic gonadotrophin (hCG)

• ultrasound scan of the pelvis, chest X-ray

Management

• suction curettage with oxytocics

• hysterectomy is an option if the woman has completed childbearing

• register in the trophoblastic registry

Follow-up

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