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Gestational Trophoblastic Disease (GTD)

GTD is a group of problems where tumors grow in the placental tissue.  There may or may not be fetal tissue present.  Two presentations within this group are hydatidiform mole and choriocarcinomas.

Hydatidiform mole (Molar pregnancy)

A hydatidiform mole is the result of a proliferation of placental tissue secondary to some problem at fertilization.

• Complete hydatidiform mole – no fetal tissue
• Incomplete hydatidiform mole – some fetal tissue present

Patient Presentation

• Nausea and vomiting
• Vaginal discharge in first trimester – brown bloody, passing grape like tissue
• High blood pressure  (preeclampsia in the first trimester)

• Greater than expected growth of the uterus
• Less than expected growth of the uterus
• Elevated hCG  > 100,000
• Doppler will not detect a fetal heart sound (there isn’t a fetal heart even though mom feels pregnant)
• U/S will show an abnormal placenta without viable fetal tissue. A description of a snowstorm is consistent with a complete hydatidiform mole.

Treatment

Regardless of complete or incomplete molar pregnancy.  There is no viable fetal tissue.  The remaining tissue must be evacuated from the uterus as in a missed abortion.  The treatment is a D&C.

Choriocarcinoma

Malignant cancer typically found in the placenta following a hydatidiform mole but may occur during any pregnancy.

Clinical Characteristics

• Vaginal bleeding
• Pain

Labs

• Elevated bHCG
• CBC
• U/S
• Chest X-ray
• MRI
• PET

Treatment

• Chemotherapy
• Hysterectomy

Study Tip

Limit distractions while you’re studying.  It has been shown in multiple studies that it takes about 15 minutes to get back on track after being interrupted.  Explain to those around you when you will be available to them.