bv

2. Hydatidiform
Mole
Mamdoh Eskandar FRCSC

3. Gestational trophoblastic Disease
 Molar pregnancy
-Complete hydatiditform mole
-Incomplete hydatiditform mole
 Choriocarcinoma
 Placental-site trophoblastic tumor

4. 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

7. 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

8. Molar Pregnancy
 Symptoms and signs of molar pregnancy
-Abnormal bleeding in early pregnancy
-Lower abdominal pain
-Toxemia before 24 weeks of gestation
-hyperemesis gravidarum

9. Molar Pregnancy
-Uterus large for dates
-No fetal heart rate
-Enlargement of the ovaries
-Hyperthyroidism
-Expulsion of swollen villi

10. 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)

11. TORONTO, CANADA, 1998, SANT.JOS. HOS.

13. 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.

14. 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.

17. 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

18. FICO Classification System of GTT
I. Confined to corpus uteri
II. Metastases to vagina or pelvic organs
III. Metastases to lungs
IV. Distant metastases

19. Prognostic Classification of
GTT
 I. Nonmetastatic GTT
 II. Metastatic GTT: disease outside the uterus.
A. Good prognosis:
1. Disease present less than 4 months
2. Pretreatment HCG is less than 40,000
3. No prior chemothreapy
4. No metastatic to the liver or the brain
B. Poor prognosis:
the opposite of good prognosis

20. Thank you!