Obstetrics and Gynecology · MU Sofia

16. Gestational trophoblastic disease

Explains gestational trophoblastic disease, from benign hydatidiform moles to malignant gestational trophoblastic neoplasia, with hCG as the marker for diagnosis and follow-up. A table contrasts complete and partial moles by karyotype, fetal findings, villi, hCG levels and risk of neoplasia. It then covers the clinical picture and management of moles, FIGO diagnostic criteria, and low- and high-risk treatment with chemotherapy regimens and cure rates.

Inside: 3 sections · 1 table · 16 flashcards · 2 min

Topic 16 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 3 sections, about 260 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Hydatidiform mole
  3. Gestational trophoblastic neoplasia

Introduction

Gestational trophoblastic disease (GTD) is abnormal proliferation of placental trophoblast. It ranges from benign molar pregnancy to malignant gestational trophoblastic neoplasia (GTN). All forms make hCG, which is the marker for diagnosis and follow-up.

Hydatidiform mole

Clinical picture

  • Vaginal bleeding in the first trimester (most common), sometimes passage of vesicles.
  • Uterus larger than dates, severe hyperemesis, early preeclampsia (< 20 weeks), hyperthyroidism, theca-lutein cysts in the ovaries (all from very high hCG). Today most moles are found early on ultrasound.
  • Ultrasound: "snowstorm" pattern with no fetus in a complete mole.

Management

  1. Suction evacuation of the uterus (not medical evacuation); histology confirms the diagnosis.
  2. Anti-D if RhD-negative; Rh status and chest X-ray before treatment.
  3. Serial hCG until normal, then follow-up for a set period (typically 6 months).
  4. Avoid pregnancy until follow-up is complete; combined pills may be used once hCG is normal.

Gestational trophoblastic neoplasia

Includes invasive mole, choriocarcinoma (can follow any pregnancy, metastasises early by blood to the lungs, vagina, brain, liver), placental site and epithelioid trophoblastic tumours.

Diagnosis after a mole (FIGO)

  • hCG plateau over 3 weeks (4 measurements) or a rise over 2 weeks (3 measurements).
  • hCG still raised 6 months after evacuation, or histological choriocarcinoma.

Treatment

  • Staging and the FIGO/WHO prognostic score: score ≤ 6 is low risk, ≥ 7 high risk.
  • Low risk: single-agent chemotherapy, methotrexate (or actinomycin D).
  • High risk: multi-agent chemotherapy, EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine).
  • Cure rates are close to 100% for low-risk and about 85–95% for high-risk disease.

hCG is the tumour marker of trophoblastic disease: it confirms the diagnosis, follows treatment and detects relapse.

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