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3 results

  • Chapter 10 - Gestational Trophoblastic Disease (GTD)

  • Edited by Swati Jha, Sheffield Teaching Hospital NHS Foundation Trust, Priya Madhuvrata, Sheffield Teaching Hospital NHS Foundation Trust
  • Book:
    Gynaecology for the Obstetrician
    Published online:
    14 July 2023
    Print publication:
    03 August 2023, pp 95-108

  • Summary

    Gestational trophoblastic disease (GTD) incorporates a spectrum of placental related disorders, with both benign and malignant (Gestational trophoblastic neoplasia (GTN)) subtypes. Upon initial presentation, one should establish diagnosis (GTD versus GTN), the requirement for chemotherapy and whether monitoring has been concluded by a specialist trophoblastic centre. Women with a prior history of GTD or GTN that have completed monitoring, or early pregnant GTD patients, do not require specialist pregnancy management. Dissimilarly, early pregnant GTN patients, particularly those treated for high-risk disease, or women with a twin pregnancy involving a complete hydatidiform mole and viable co-existent foetus should receive detailed antenatal counselling and be managed under consultant-led care. Patients with a twin mole and viable co-existent foetus have a high risk of antenatal, intrapartum and post-partum complications. Fortunately, in women with a prior history of trophoblastic disease, live birth rates equal the general population, with no increased risk of disease relapse.

  • Chapter 14 - Inherited thrombophilia and early pregnancy

  • Edited by Roy G. Farquharson, University of Liverpool, Mary D. Stephenson, University of Chicago
  • Book:
    Early Pregnancy
    Published online:
    05 October 2010
    Print publication:
    09 September 2010, pp 131-142

  • Summary

    Molar pregnancies are characterized by gross water logging and villous cistern formation. Villous trophoblastic hyperplasia is the microscopic characteristic feature of true molar pregnancies. This chapter reviews the role of ultrasound in early pregnancy in the screening for molar pregnancy. Complete moles are almost always diploid with their chromosomes totally derived from the paternal genome resulting from endoreduplication after monospermic fertilization or more rarely dispermic fertilization of an anucleate oocyte. Usually, the ultrasonographic description of complete hydatidiform moles (CHM) applies to pregnancies between 9 and 12 weeks of amenorrhea. In early pregnancy and in particular in missed miscarriage, independently of the presence of a chromosomal abnormality, the progressive disappearance of the villous vasculature after embryonic death leads to villous hydrops. Overall, the risk of persistent Gestational trophoblastic disorder (pGTD) developing from a histologically confirmed non-molar hydropic miscarriage is considered to be less than 1 in 50,000.

  • 17 - Gestational trophoblastic neoplasia

  • from SECTION 5 - The Placenta
  • Edited by Sean Kehoe, Eric Jauniaux, Pierre Martin-Hirsch, Philip Savage
  • Book:
    Cancer and Reproductive Health
    Published online:
    05 October 2014
    Print publication:
    01 November 2008, pp 205-226

  • Summary

    Gestational trophoblastic neoplasia (GTN) comprises a spectrum of related conditions, all of which are characterised by low incidence and high cure rates. Placental site trophoblastic tumours (PSTT) are the rarest form of GTN and can complicate any form of conception but most frequently follow a normal pregnancy. Choriocarcinoma can present with extremely varied symptoms and signs associated with the differing sites of metastatic disease and occur at a wide range of time after the causative pregnancy. For most women with GTN following a recent molar pregnancy, the investigations performed before chemotherapy treatment are limited to a Doppler ultrasound of the pelvis and a chest X-ray. The use of routine first-trimester ultrasound combined with effective follow-up programmes has produced near 100% cure rates for women following molar pregnancies. Optimising molar pregnancy follow-up services and education of clinicians to GTN in women with cancer are most important to produce effective patient care.