This document discusses gestational trophoblastic disease (GTD), including its definition, classification, genetics, clinical presentations, complications, diagnosis, management, indications for chemotherapy and hysterectomy, prognostic scoring, and chemotherapy regimens and side effects. GTD encompasses a spectrum of conditions from benign partial and complete moles to malignant invasive moles, choriocarcinoma, and other rare subtypes. Diagnosis involves history, clinical exam, imaging and biochemistry. Treatment depends on risk stratification and may involve surgery, chemotherapy, or hysterectomy.

1. GESTATIONAL
TROPHOBLASTIC
DISEASE
DR RAISHEM ALI
ASSOCIATE PROF:
OBGYN
PUMHS

3. GESTATIONAL TROPHOBLASTIC
DISEASE
Defination Clinical presentation
Genetics Complications
Classification Diagnosis
Partial mole Management
Coplete mole a. Registration
Invasive mole Indication of chemotherapy
Choriocarcinoma Prognostic scoring
PSTT Chemotherapy (agents, complications)
ETT Indication of hysterectomy

4. GESTATIONAL TROPHOBLASTIC
DISEASE
• Definition
• Classification
Benign
a) PM
b) CM
• Malignant
a. Invasive mole
b. CC
c. PSTT
d. ETT

5. GESTATIONAL TROPHOBLASTIC DISEASE
GENETICS
• CM
• Diploid
Androgenitc
Monospermic
Dispermic
Biparental

6. GESTATIONAL TROPHOBLASTIC DISEASE
GENETICS
• PM
1. Triploid
2. Tetraploid
3. Mosaic

7. GESTATIONAL TROPHOBLASTIC DISEASE
CLINICAL PRESENTATIONS
Common
Less common
Rare

8. GESTATIONAL TROPHOBLASTIC DISEASE
COMPICATIONS
• Immediate
• Late

9. GESTATIONAL TROPHOBLASTIC DISEASE
DIAGNOSIS
• Hx
• Clinical findings
• Investigations …
Biochemistry
Imaging

10. GESTATIONAL TROPHOBLASTIC DISEASE
MANAGEMENT
• Registraton
• Treatment .. Suction curretege
• Histopathology

11. GESTATIONAL TROPHOBLASTIC DISEASE
INDICATION OF CHEMOTHERAPY
• Serum beta hcg
Increases
Plateu
>2ok at 4 weeks
Raised at 6 month
• Histopathology
• Metastasis

12. GESTATIONAL TROPHOBLASTIC DISEASE
PROGNOSTIC SCORING
• Low risk
• High risk

14. GESTATIONAL TROPHOBLASTIC DISEASE
CHEMOTHERAPY
low risk
MTX
Actinomycin D/ EMA/CO
High risk
EMA/CO, EP/EMA, TE/TP

15. GESTATIONAL TROPHOBLASTIC DISEASE
CHEMOTHERAPY
• Side effects
• Effect on fertility
Menopause
CONTRACEPTION ???

16. GESTATIONAL TROPHOBLASTIC DISEASE
INDICATION OF HYSTERECTOMY
• ?????
• Indication of repeat evacuation
• Followup
 after PM
 after CM
 after malignancy