GESTATIONAL TROPHOBLASTIC DISEASE I:

EPIDEMIOLOGY, PATHOLOGY, CLINICAL

PRESENTATION AND DIAGNOSIS OF GESTATIONAL
TROPHOBLASTIC DISEASE, AND MANAGEMENT OF
HYDATIDIFORM MOLE

Presented by :
Nita Corry Agustine Nias Waruwu

Facilitated by :
Dr. Maruarar Panjaitan, SpOG
 Introduction

Gestational trophoblastic disease includes hydatidiform mole

and gestational trophoblastic neoplasia (invasive mole,
choriocarcinoma, placental site trophoblastic tumor,
and epithelioid trophoblastic tumor).
Particular emphasis is given to management of hydatidiform
mole, including evacuation, twin mole/normal fetus
pregnancy, prophylactic chemotherapy, and follow-up.
 Epidemiology
North America, Australia, New Zealand, & Europe → incidence of
hydatidiform mole to range from 0.57–1.1 per 1000 pregnancies.
Southeast Asia and Japan → an incidence as high as 2.0 per 1000
pregnancies.
Europe & North America, choriocarcinoma → 1 in 40,000 pregnancies & 1 in
40 hydatidiform moles. Southeast Asia & Japan choriocarcinoma rates are
higher at 9.2 and 3.3 per 40,000 pregnancies, respectively.
Women aged 21-35 years, the risk of complete mole is 1.9 times higher for
women both 35 years & 21 years as well as 7.5 times higher for women 40
years.
There also seems to be an increased risk of choriocarcinoma in women with
long-term oral contraceptive use and blood group A.
 Pathology

Normal trophoblast is composed of :


Cytotrophoblast

Syncytiotrophoblast

Intermediate trophoblast

All 3 types of trophoblast result in GTD when they proliferate.

 Clinical Presentation
Complete hydatidiform mole :
 Vaginal bleeding (80-90%)

Uterine enlargement (28%)

Hyperemesis (8%)

Pregnancy-induced hypertension (1%)

USG : bilateral theca lutein cyst enlargement (15%), fetal heart (-).

Lab : hCG levels > 100,000 mIU/mL

Partial mole :
Irregular bleeding

Enlarged, irregular uterus

Persistent bilateral ovarian enlargement

Pulmonary symptoms

serum hCG levels are only slightly elevated

Gestational trophoblastic neoplasia :

Incomplete or missed abortion

Vaginal bleeding (75%)

Excessive uterine enlargement

Hyperemesis, pregnancy-induced hypertension, hyperthyroidism

USG : theca lutein cysts develop infrequently

Lab : hCG levels > 100,000 mIU/mL (<10%)

 Diagnosis

Ultrasonography : hCG serum :

plays a critical role in the
diagnosis of both
complete and partial
mole, and it has virtually
replaced all other means
of preoperative diagnosis.
easily measured
quantitatively in both
urine and blood, hCG levels
have been shown to
correlate with the burden
of disease.
 Diagnosis

Pathologic diagnosis :
Pathologic diagnosis of complete and partial moles is
made by examination of curettage specimens.
Additionally, pathologic diagnosis of invasive mole,
choriocarcinoma, PSTT, and ETT can sometimes be
made by curettage, biopsy of metastatic lesions, or
examination of hysterectomy specimens or placentas.
 Hydatidiform mole : Treatment
Diagnosis of molar pregnancy :
– History, physical examination, hCG levels, and ultrasound findings.
– Evaluation of medical complications → vital signs & laboratory
tests.
– Preoperative evaluation →blood type & crossmatch, serum hCG ,
ECG.

The diagnosis is confirmed and the patient is determined to be

hemodynamically stable, the most appropriate method of molar
evacuation should be decided upon.
Prophylactic administration of either methotrexate or actinomycin D
chemotherapy → have to be limited.
 Follow-up after molar evacuation
Follow-up after evacuation of a hydatidiform mole → detect trophoblastic
sequelae (invasive mole or choriocarcinoma) → develop in approximately
15-20% with complete mole and 1-5% with partial mole.
Serial serum quantitative hCG measurements every 1-2 weeks until 3
consecutive tests show normal levels, after which hCG levels →
determined at 3-month intervals (6 months) after the spontaneous return
to normal.
Contraception → 6 months after the first normal hCG result.
Pathologic examination of the placenta and other products of conception as
well as determination of a 6-week postpartum hCG level is recommended
with all future pregnancies.
THANK YOU