Gestational trophoblastic-diseases(molar pregnancy)

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  • 1. Hydatidiform MoleMamdoh Eskandar FRCSC
  • 2. Gestational trophoblastic Disease Molar pregnancy-Complete hydatiditform mole-Incomplete hydatiditform mole Choriocarcinoma Placental-site trophoblastic tumor
  • 3. Molar Pregnancy Complete mole  Incomplete mole- Fertilization an empty egg by -fertilization of an egg by two one sperm. sperms-All placental villa swollen. -some placental villa swollen-Fetus, cord, amniotic - Fetus, cord, amniotic membrane are absent. membrane are present-Paternal chromosomes only. 46 - Paternal and maternal XX. 69XXY-diploidy -Triploid
  • 4. Molar Pregnancy Incidence and epidemiology:-In USA 1:1000-In Asia 8:1000 Risk factors for molar pregnancy:-Extreme of age-Lower socioeconomic status-Race and ethnic origin-Blacks have lower incidence
  • 5. Molar Pregnancy Symptoms and signs of molar pregnancy-Abnormal bleeding in early pregnancy-Lower abdominal pain-Toxemia before 24 weeks of gestation-hyperemesis gravidarum
  • 6. Molar Pregnancy-Uterus large for dates-No fetal heart rate-Enlargement of the ovaries-Hyperthyroidism-Expulsion of swollen villi
  • 7. Molar Pregnancy Diagnosis:-Ultrasound shows snowstorm-like appearance, no fetus, theca lutein cyst-Beta hCG in normal pregnancy the level is at it peak at around 14 weeks (100,000 mIU/ml)
  • 8. TORONTO, CANADA, 1998, SANT.JOS. HOS.
  • 9. Management Once the diagnosis is made evacuation of the uterus should be done but prior to that:hCG preevacuation. Chest x-ray. Correct: anemia, toxemia, hyperthyroidism, pulmonary compromise.
  • 10. Follow up HCG weekly until normal for two values then monthly for one year. Repeat x- ray if HCG rises or plateau. Contraception for one year. Pelvic examination every 3 weeks for 3 months.
  • 11. Follow up Initiate chemotherapy if:-HCG level is increasing or plateaus-Metastasis disease is present-HCG level is still elevated after 6 months of evacuation-HCG starts to rise after being undetectable
  • 12. FICO Classification System of GTTI. Confined to corpus uteriII. Metastases to vagina or pelvic organsIII. Metastases to lungsIV. Distant metastases
  • 13. Prognostic Classification of GTT I. Nonmetastatic GTT II. Metastatic GTT: disease outside the uterus.A. Good prognosis:1. Disease present less than 4 months2. Pretreatment HCG is less than 40,0003. No prior chemothreapy4. No metastatic to the liver or the brainB. Poor prognosis: the opposite of good prognosis
  • 14. Thank you!