Molar Gestation. Overview, Types of Molar Pregnancy. Radiologic evaluation of Molar Pregnancy. Ultrasound scan Findings in Gestational Trophoblastic Disease. Radiology Training Resource for Medics and Paramedics

1. RADIOLOGY TRAINING RESOURCE FOR MEDICAL
IMAGING TECHNOLOGISTS/SONOGRAPHERS,
NURSES, MIDWIVES AND RELATED MEDICS
Module 6: Understanding Gestational
Trophoblastic Disease (GTD) And
Ultrasound Evaluation
Course lecturer
Nchanji Nkeh Keneth
Radiologic Technologist/Sonographer
CSMRR: 001012016
+237 671459765
B.TECH/HPD in MDIRT
(St. LOUIS UNIHEBS, Univ Buea)
excellence660@gmail.com
MedicalImagingTrainingResourceForMedicalImag
Tech,Nurses,MidwivesandMedics,NchanjiNkehKeneth
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10/23/2020

2. Presentation outline
An overview of GTD, types and
prevalence
Causes of GTD, s/s, diagnosis,
management
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3. General Introduction
Gestational Trophoblastic Diseases are a group of
diseases originating from trophoblastic cells
GTD is a common gynecologic problem among
women in the world particularly those in Asia and
Africa [1, 2]
In the US and Europe, about 1/1500
pregnant women has GTD
In South East Asia, about 1/150
In Africa????????????
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4. GTD is Curable
GTD is associated with increase levels of β-hCG
[1-2]
 Metastatic forms of GTD are also
encountered[3-7]
 Three Main Types of GTD exist: Hydatidiform
mole, Invasive mole (chorioadenoma),
Choriocarcinoma and also the rarely seen
Placental Site Trophoblastic Tumor) [3]
 GTD manifests in several ways
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5. Classification of GTD
1. Hydatidiform Mole:
It could be complete , partial or mole coexisting
with pregnancy
Characterised by hydrophic swellings
Placenta contains several cystic areas
Bilateral Ovarian Cystic lesions (theca Luteal
Cysts) are seen in complete mole [3]
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6. Classification of GTD Cont
2. Invasive Mole (Chorioadenoma or
malignant non-Metastatic Trophoblastic
Dxs)
3. Choriocarcinoma (which is metastatic,
could move to the lungs, brain and other
parts of the body)
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8. Pathogenesis of GTD
 Complete mole
- Fertilization of an empty
egg by one sperm.
-All placental villa
swollen.
-Fetus, cord, amniotic
membrane are absent.
-Paternal chromosomes
only. 46 XX.
-diploidy
 Incomplete mole
-fertilization of an egg by
two sperms
-some placental villa
swollen
- Fetus, cord, amniotic
membrane are present
- Paternal and maternal
69XXY
-Triploid
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21. Risk factors of GTD [6]
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 Age:
 The risk of complete molar pregnancy is highest in women over
age 40 and younger than 20.
 Age is less a factor for partial moles.
 all women of childbearing age are at risk for the disease.
 Pregnancy number: Nulliparous women are at more risk.
 Having a molar pregnancy before:
 Once a woman has had a hydatidiform mole, there is about a 1
in 60 chance that she will have another one.
 It is important to remember that 98% of subsequent pregnancies
will be normal.
 Blood type:
 Women with blood type A or AB are at slightly higher risk than
those with type B or O.

22.  Birth control pills:
 Women who take birth control pills are about
50% more likely to get GTD when they do
become pregnant.
 This risk is lower for shorter use of birth
control pills and higher for longer use.
 But the risk is still so low that it doesn’t
outweigh the benefit of using the pills.
 Lifestyle:
 smoking and drinking alcohol can increase the
risk of GTD.
 Number of sexual partners: Having more than 10
sexual partners increases the risk of GTD.
 Socioeconomic status: Lower socioeconomic
status has been associated with an increased risk.
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23. Clinical S/S [1-7]
Vaginal bleeding97 (95.1)
Hyperemesis4 (3.9)
Symptom of thyrotoxicosis1 (1)
Clinical diagnosis miscarriage31 (30.4)
Hypertension4 (3.9)
Sign of thyrotoxicosis1 (1.0)
Uterus larger than dates18 (17.6)
Ultrasound ‘snow-storm’ feature48 (47.1)
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24. Diagnosis of GTD
Lab tests (evaluates and monitor the
levels of β-hCG )
Ultrasound Scans
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25. Ultrasound Scan
1. Reveals “snow stormy” appearance of
the uterus
2. Reveals Theca Luteal Ovarian Cysts
3. Differentiates between the types of
Mole
4. Detects the extent of invasion
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30. Rx of GTD
1.Curettage
2.Chemotherapy
3.Hysterectomy
4.Radiation Therapy
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31. Follow Up
To ensure hCG levels stabilize
(9months), to less than 5iu/l
Chest X rays, CT Scans, MRI
Scans etc to evaluate metastasis
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32. Reasons for subsequent Imaging Studies
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36. References
1. Nirmala CK, Harry SR, Nor Azlin MI, Lim PS, Shafiee MN, Nur Azurah AG,
Shamsul AS, Omar MH and Hatta MD (2014), “Molar Pregnancy: Follow-up
Beyond One Undetectable Serum β-hCG, IS IT NECESSARY?” Department of
Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan
Malaysia, Kuala Lumpur. Malaysia.
1. Gestational Trophoblastic Disease: Current Management
2. Etta Peter (2014). Obstetric and Gynecological Ultrasound Scan. Department of
Radiology, St. Louis University, Mile 3 Nkwen Bamenda
3. Gestational Trophoblastic Disease, Hydatidiform Mole
4. YASHODHARA PRADEEP. Gestational Trophoblastic Disease. Gestational
Trophoblastic Disease
5. Dr. F Behnamfar MD.Diagnosis and treatment of gestational trophoblastic disease
6. Amir Nadim. Gestational Trophoblastic Disease (GTD). Professor of Obstetrics &
GynecologyAin Shams Faculty of Medicine
[amrnadim@link.net]
7. Ahmed Refaat Abd Elzaher. Gestational Trophoblastic Disease (GTD). Assistant
Lecturer of Medical OncologySouth Egypt Cancer Institute 2015
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37. Beri wi ba’a ghor
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