Gestational Trophoblastic Disease

Published on 30/05/2015 by admin

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Last modified 30/05/2015

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Chapter 208 Gestational Trophoblastic Disease

INTRODUCTION

Description: Gestational trophoblastic diseases include choriocarcinoma, molar pregnancy (hydatidiform mole and invasive mole), and placental-site trophoblastic tumor. They are abnormalities of pregnancy that arise entirely from abnormal placental proliferation. They are classified as being either complete, in which no fetus is present, or incomplete (partial), in which both fetus (generally abnormal) and molar tissues are present.

Prevalence: Molar pregnancy—1 of 1000 to 1500 pregnancies in the United States, as high as 10 per 1000 pregnancies in Asia; choriocarcinoma—1 of 40,000 pregnancies.

Predominant Age: Greatest during the early and late reproductive years.

Genetics: Complete—mostly 46,XX (paternal in origin, although mitochondrial DNA remains maternal in origin). Incomplete—triploid (69,XXY or 69,XXX; all of paternal origin).

ETIOLOGY AND PATHOGENESIS

Causes: Unknown.

Risk Factors: Maternal age (older than 40: 5.2 times risk), Asians living in Southeast Asia, folate deficiency, prior molar pregnancy (2% recurrence rate).

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Present as a pregnancy but associated with more profound hormonal changes, leading to exaggerated symptoms of pregnancy in many patients

• Uterine size that is inappropriate for dates (larger or smaller, 30%)

• Painless vaginal bleeding (95%, generally between 6 and 16 weeks of gestation)

• Hypertension, pre-eclampsia, proteinuria, nausea and vomiting (hyperemesis, 8%), visual changes, tachycardia, and shortness of breath all possible (pregnancy-induced hypertension in the first trimester of pregnancy is virtually diagnostic)

• Incomplete molar pregnancies—symptoms of an incomplete or missed abortion (90%), including vaginal bleeding (75%)

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Netters Obstetrics and Gynecology