This document provides an overview of gestational trophoblastic disease (GTD). It begins by outlining the learning objectives, which are to understand what GTD is, diagnose and treat cases of GTD, and follow up with patients. The introduction then defines GTD as an abnormal proliferation of trophoblastic tissue, ranging from benign moles to malignant choriocarcinoma. The document goes on to classify GTD and discuss the incidence, aetiology, risk factors, and risk of molar pregnancy. It provides details on metastatic malignant GTD, management of metastasis, and concludes with an overview of GTD.

1. LEARNING OUTCOMES
By the end of presentation, the participants should be able to:
1. What is gestational trophoblastic disease
2. Diagnose a case of gestational trophoblastic disease.
3. Plan treatment for a case of gestational trophoblastic disease.
4. Follow up of case
July 4, 2023 1

2. INTRODUCTION
Abnormal proliferation of gestational
trophoblastic tissue that forms a
spectrum of diseases from the benign
partial hydatidiform mole to the
malignant choriocarcinoma and
placental site trophoblastic tumours.
July 4, 2023 2

3. CLASSIFICATION
1. Molar pregnancy (benign)
 Partial
 Complete
2. Persistent or residual mole
 Invasive
 Placental site
3. Choriocarcinoma
 Nonmetastatic
 Metastatic: (Low & high Risk Metastatic)
July 4, 2023 3

4. CONTI…
I. Benign GTN
A. Hydatidiform mole
 Complete
 Partial
B. Other Types
 Placental site trophoblastic disease.
 Invasive and persistent trophoblastic disease.
II. Nonmetastatic malignant GTD.
III. Metastatic malignant GTD
July 4, 2023 4

5. METASTATIC MALIGNANT GTD
A. Good prognosis (Low Risk)
 Duration of disease from termination of pregnancy to initiation of chemotherapy is less than 6 months.
 Pretreatment urine hCG level less than 1000 IU/ 24 h or serum 𝛽-hCG 40,000–50,000 mIU/mL.
 Metastatic disease limited to the pelvis or lungs.
 No significant prior chemotherapy.
B. Poor prognosis (High Risk)
 Duration of the disease from termination of pregnancy to initiation of chemotherapy more than 6 months.
 High serum hCG level —50,000 mIU/mL or more.
 Lungs, Brain, liver metastasis
 Metastatic choriocarcinoma following a term pregnancy
July 4, 2023 5

6. MANAGEMENT OF METASTASIS
July 4, 2023 6

7. INCIDENCE
 Geographical and racial variation
 Higher in Africa and Asia (10-15%)
 In Europe and North America 0.2-1.5 / 1000 LB.
 Extremes of reproductive age
 Higher in teenage pregnancies (1.3 fold) & above 40yrs (10 fold)
 18-40 yr - 40%
 >45 yr - 90%
 Complete mole – 1:1000
 Partial mole – 3:1000.
July 4, 2023 7

8. AETIOLOGY
 Immunological factors
 Racial factors
 Dietary factors (Poor rice diet and vitamin A deficiency,𝛽 carotine deficiency,Dietary deficiency
in protein, folic acid and iron)
July 4, 2023 8

9. RISK FACTORS
 Age: extremes of age <15 yr and>40 yr
 Reproductive history:
 Low socioeconomical status
 Multiparity
 Prior Molar Pregnancy
 Previous spontaneous abortion: double the incidence (Second molar: 1% -Third molar : 20%)
 Diet: increase incidence in high carbohydrate diet, low protein and Vit. A or carotene diet
(complete mole)
 Malnutrition and debilitated condition
 Repetitive H. moles in women (2-10%)
July 4, 2023 9

10. RISK OF MOLAR PREGNANCY
July 4, 2023 10