obstetrics & gynecology,

1. Gestational Trophoblastic
Diseases
Sana Afridi
Final year MBBS
08-168

2. Objectives
• What is gestational trophoblastic
diseases?
• Classification of gestational
trophoblastic diseases.
• Clinical picture, signs symptoms.
• Diagnosis, treatment of is gestational
trophoblastic diseases.

3. Gestational Trophoblastic Diseases
• Gestational trophoblastic
diseases represent a
unique spectrum of
tumors and tumor like
conditions characterized
by proliferation of placenta
tissue either villous or
trophoblastic.

4. • the incidence of GTD varies
greatly between different
parts of the world.
• The reported incidence of
hydatidiform mole ranges
from 23 to 1299 cases per
100,000 pregnancies.
Epidemiology

5. Predisposing Factors:-
• Age below 15 and above 40 years.
• Previous History of hydatidiform mole
• Previous Miscarriage
• Excessive smoking
• Reduced B carotene intake

6. PATHOLOGICAL CLASSIFICATION
1. Hydatiditorm mole.
(85 %)
2. Invasive mole. (12-15%)
3. Gestational choriocarcinoma.(5-8%)
4. Placental site Trophoblastic tumor.
Complete
Partial

7. Clinical Classification.
Benign ( 80%). Malignant (20%).

8. Hydatidiform Mole ( Molar
Pregnancy)
• It is an abnormal
pregnancies in which
chorionic villi become over
distended with fluid and
form grape like vesicle
which vary in size from few
millimeters to few
centimeters.

9. Types of Hydatidiform mole
• Complete mole
• Partial mole

10. Complete Mole
• An abnormal pregnancy which consists of
placental tissue only and there is no embryo
in it.
 Pronounced trophoblastic hyperplasia
having both cytotrophoblastic and synctial
elements.

11. Etiology: complete mole
• It develops when
either 1 or 2 sperm
cells fertilize an
“empty” egg cell
empty-means no
DNA. All genetic
material came from
the sperm cell

12. Complete MOLE

13. Partial mole
• In this form the embryo or fetus coexist with
placenta abnormality through it tends to die
at an early cystitis.
• In abnormal parts of placenta the hyperplasia
only involve synctiotrophoblast.

14. Partial mole: etiology
 2 sperms fertilize a
normal egg.
 Or a sperm that has
failed to undergo
meiotic division fertilize
normal egg.

15. Clinical Features: SYMPTOMS
• Symptoms of early pregnancy:- Patients
history of amenorrhea usually for 4-6 months.
.

16. Clinical presentation
• Vaginal Bleeding:- Patient complains of
recurrent vaginal bleeding something there is
history of brownish vaginal discharge.
Bleeding usually starts is 3rd or 4th months of
pregnancy.

17. • Absence of Quickening:- Fetal movements
are never felt except in partial mole.

18. Clinical features: SIGNS
1. Size of uterus:- In most cases the size of
uterus is excessively larger than expected for
duration of amenorrhea.
2. Absence of uterus Contractions:- In molar
pregnancy the uterus feels doughy and does
not contract.

19. 3.Bilateral ovarian enlargement:- In 25% cases
bilateral ovarian enlargement palpable.
4.Absence of Foetal Part:- Foetal part not
palpable and feotal heart is absent.
5.Pre eclampcia:- In 50% case signs of
preeclampsia especially in first half of
pregnancy.

20. DIAGNOSIS
• Ultrasonography: Snow storm appearance on
ultrasound.
• Beta HCG level:- HCG ideal marker for diagnosis
of gestational trophoblastic disease. Hcg is
produced by synctiotrophoblast cell of placenta.
In normal pregnancy its max amount is produced
at 8-10 weeks and after it falls..
• In molar pregnancy it is produced in very large
amount and its serum and urine level continue to
risk beyond 12 weeks of amenorrhea.

21. • Pre Treatment Investigations:-
Include:-
• Hb estimation diagnosis of anemia.
• Blood grouping and cross matching for
transfusion.
• X.ray chest To rule out primary
metastasis.
• T3 and T4 estimates. When thyrotoxicosis is
expected.

22. Treatment
• The aim of treatment is to remove
trophoblastic tissue from uterus and eliminate
it from other body system.

23. Evacuation of H Mole
1. Suction Curettage.
Method of choice for evacuation of H mole
under 16 weeks of gestation
• After General Anesthetic → cervix is dilated to
size of 12mm.
• Suction curette is introduced →
• A negative pressure of 60-70 cm H2O is
created and suction preformed

24. • while all mole
tissue is aspirated
→ when uterus
has firmly
contracted, gentle
curettage is
performed →
and curetting sent
for
histopathology.

25. Invasive Mole :
• Its is a complication of hydatidiform mole but
may rarely develop after partial mole. Invasive
mole may metastasize to any part of body but
commonly involves lungs.

26. Choriocarcinoma :
• It is rapidly
progressive , highly
malignant tumor
which originates
from chorionic
epithelium

27. Clinical features :
• Vaginal bleeding: intermittent vaginal bleeding
• Vaginal discharge: brownish vaginal discharge
• Other: weakness
• Cough
• Neurological symptoms
• Abdominal or vaginal mass
• Amenorrhea
`

28. Investigations:
• Raised hCG levels
• Biopsy
• X-ray Chest
• Ultrasonography
• C.T scan

29. Treatment
• Chemotherapy
• Surgery: Hysterectomy.

31. THANKS