GESTATIONAL

TROPHOBLASTIC
DISEASE
(Hydatidiform Mole)

Gylle Marie Plaza

Prince Waver Mondragon
 Gestational Trophoblastic Disease (GTD) is a group of tumors defined by abnormal
proliferation and then degeneration of the trophoblastic villi. As the cells degenerate, they become filled
with fluid and appear as clear fluid-filled, grape-sized vesicles. The embryo fails to develop beyond a
primitive start. This refers to a molar pregnancy also called hydatidiform moles. GTD is divided
into hydatidiform moles and other trophoblastic neoplasms. The non-molar or
malignant forms of GTD are called gestational trophoblastic neoplasia (GTN).

Gestational trophoblastic disease (GTD) is a general term that includes different types of disease:

• Hydatidiform Moles(HM)
Complete HM.
Partial HM.
• Gestational Trophoblastic Neoplasia (GTN)
Invasive moles
Choriocarcinomas
Placental-site trophoblastic tumors (PSTT; very rare).
Epithelioid trophoblastic tumors (ETT; even more rare).
Two Types of Molar Growth
Complete Mole
• All trophoblastic villi swell and become
cystic.
• Karyotype: 46 chromosomes, 46XX or
46XY
• Contributed only by the father or an
“empty ovum” was fertilized and the
chromosome material was duplicated.
Partial Mole
• some of the villi form normally, however, is
swollen and misshapen.
• Karyotype: 69 chromosomes
• one set supplied by an ovum that apparently
was fertilized by two sperm or an ovum
fertilized by one sperm in which meiosis or
reduction division did not occur.
 DIAGNOSI
 S
Physical examination and History: General signs of health, including checking for signs of disease. History of the
patient’s health habits and past illnesses and treatments. 


Bimanual examination: Assess uterine size. GTD causes the uterus to reach its landmarks (just over the symphysis brim at 12
weeks, at the umbilicus at 20 to 24 weeks) before the usual time.


Serum or urine test of hCG: -1 to 2 million IU compared with a normal pregnancy level of 400,000 IU.


Transvaginal Ultrasound (Ultrasonography)
:With complete moles theca lutein cysts may be found on one or both ovaries.
:With incomplete moles, fetal parts may be visible.

Vaginal Bleeding: Presence of clear fluid-filled cysts.

Blood Tests: use blood samples to check the levels of certain hormones and
other substances that may be impacted by the presence of GTD.

Other scans: including x-rays, computed tomography (CT) or magnetic
resonance imaging (MRI).
 RISK
FACTORS

Dietary deficiencies: including lack of folate, beta-carotene or low protein
intake.

Maternal Age Extremes

Women younger than 20 and older than age 35.


Race: Women of Asian heritage are at increased risk.

Blood type: Specific blood types A and AB may slightly increase the risk of GTD.

Obstetric history
Previous molar pregnancy, spontaneous abortion or infertility.
 SIGNS &
SYMPTOMS

Missed menses or vaginal bleeding during early pregnancy.

Enlarging uterus, feeling of pelvic pressure.
Partial mole: small or normal for gestational age
Complete mole: large for gestational age

Abnormal appearance of the uterine cavity at ultrasound (called a snowstorm pattern).

Hyperemesis gravidarum
Nausea and vomiting which can lead to dehydration

Hyperthyroidism
Insomnia, anxiety, warm skin, tremor, heat intolerance, tachycardia, and palpitations, as well as
the formation of theca lutein cysts on the ovaries.
COMPLICATIONS
 Hemorrhage
 Ovarian cysts
 Breathlessness (when it spreads to the lungs)
 Excess thyroid hormone production
 Trophoblastic pulmonary emboli
 Increased hCG level leads to theca lutein cysts, hyperthyroidism, preeclampsia (also known as toxemia)—a
pregnancy-related condition which can cause a sharp rise in blood pressure.

If a molar pregnancy is not treated or does not miscarry completely:

 Persistent GTD – persistent growth of the abnormal placental tissue

 Invasive mole – the tumor spreads into the wall of the uterus
 Metastatic mole – molar cells migrate to other organs of the body and cause secondary tumors. The
lungs are common sites for metastatic moles.
 Gestational choriocarcinoma – a rapidly spreading type of cancer that can travel to any part of the
body via the blood vessels or lymphatic system.
 PREVENTIVE
MANAGEMENT
There are no preventive medicines or treatments for GTD. The only way to prevent
this very rare disease is to not become pregnant. An early screening with ultrasound during
a second pregnancy is needed for women who have one incidence of gestational
trophoblastic disease. GTD is so rare that its prevention should not be a factor in family
planning decisions. If a woman have a condition that puts you at risk for GTD, they may
benefit from consulting with a genetic counselor to determine the risk.
 MEDICAL OR SURGICAL MANAGEMENT

Uterine evacuation: suction curettage. The cervix is dilated and the material inside the uterus is removed  with a small
vacuum-like device and the walls of the uterus are then gently scraped with a curette (spoon-shaped instrument).

Contraceptive Method: Serum hCG levels are assessed every 4 weeks for the next 6 to 12 months with the use a reliable contraceptive method such as an oral
contraceptive agent for 12 months.

Methotrexate: the drug of choice for choriocarcinoma.

Dactinomycin is added to the regimen if metastasis occurs.


Hysterectomy: Surgical removal of the uterus. In a
total hysterectomy, the uterus and cervix are
removed. In a total hysterectomy with salpingo-
oophorectomy, the uterus plus one ovary and
fallopian tube are removed; or the uterus plus both
ovaries and fallopian tubes are removed. In a radical
hysterectomy, the uterus, cervix, both ovaries, both
fallopian tubes, and nearby tissue are removed.
These procedures are done using a low transverse
incision or a vertical incision.
EFFECTS ON PREGNANCY

Feeling of loss after its evacuation that the woman would have experienced after the
loss of a true pregnancy.

possibility that a malignancy may develop.

Delay childbearing plans for a year.

One incidence of gestational trophoblastic disease have an increased risk of a second
molar pregnancy.

She experiences the symptoms of pregnancy because the placenta continues to make the
pregnancy hormone human chorionic gonadotrophin (hCG).
PROGNOSIS
Almost all females with this condition achieve a complete cure and have an excellent
survival rate.

Hydatidiform moles are curable in 100 percent of cases. Further treatment is required
in 10 percent of all cases. There is a 15 to 25 percent of a complete mole persisting and a 0.5
to 4 percent chance of a partial mole

If the level of HCG does not return to normal or increases, it may mean the
hydatidiform mole was not completely removed and it has become cancer. For disease that
remains after surgery, treatment is usually chemotherapy.