Below is a **single-place, comprehensive, exam-oriented + clinical reference** on **Gestational Trophoblastic Diseases (GTD)**, structured exactly for **medical study, practice, and management**. --- # **Gestational Trophoblastic Diseases (GTD)** ## **Definition** Gestational Trophoblastic Diseases are a **spectrum of pregnancy-related disorders** arising from **abnormal proliferation of trophoblastic tissue** (placental tissue). They range from **benign hydatidiform mole** to **malignant gestational trophoblastic neoplasia (GTN)**. --- ## **Classification** ### **1. Non-neoplastic GTD** * **Complete hydatidiform mole** * **Partial hydatidiform mole** ### **2. Gestational Trophoblastic Neoplasia (GTN)** * **Invasive mole** * **Choriocarcinoma** * **Placental site trophoblastic tumor (PSTT)** * **Epithelioid trophoblastic tumor (ETT)** --- ## **Epidemiology** * Incidence: **1–2 per 1000 pregnancies** * Higher in: * Extremes of maternal age (<15, >40) * Prior molar pregnancy * Asian populations * Recurrence risk: * After one mole: **1–2%** * After two moles: **15–20%** --- ## **Pathophysiology & Genetics** ### **Complete Mole** * **46XX or 46XY** * Entirely paternal genome (androgenesis) * Empty ovum fertilized by sperm → duplication * **No fetus** ### **Partial Mole** * **Triploid (69XXX/XXY/XYY)** * Two sperms fertilize one ovum * **Abnormal fetus may be present** --- ## **Clinical Features** ### **Symptoms** * Amenorrhea * Vaginal bleeding (most common) * Excessive vomiting (hyperemesis gravidarum) * Early-onset preeclampsia (<20 weeks) * Hyperthyroid symptoms (↑ β-hCG) * Passage of grape-like vesicles (rare) ### **Signs** * Uterus larger than gestational age (complete mole) * Absent fetal heart sounds * Bilateral theca-lutein ovarian cysts --- ## **Investigations / Diagnosis** ### **Laboratory** * **β-hCG**: * Markedly elevated (often >100,000 IU/L) * Thyroid function tests (rule out thyrotoxicosis) * CBC (anemia) * Liver, renal function tests * Blood group & Rh typing ### **Imaging** * **Ultrasound (gold standard)** * Complete mole: *“Snowstorm / cluster of grapes”* * Partial mole: fetus + cystic placenta * Chest X-ray (baseline for metastasis in GTN) ### **Histopathology** * Definitive diagnosis after evacuation --- ## **Differential Diagnosis** * Missed abortion * Multiple pregnancy * Ectopic pregnancy * Placental mesenchymal dysplasia * Subchorionic hemorrhage --- ## **Management** ### **Initial Management of Hydatidiform Mole** #### **1. Uterine Evacuation** * **Suction evacuation + curettage (preferred)** * Oxytocin infusion after evacuation * Hysterectomy (if completed family + >40 yrs) #### **2. Anti-D Immunoglobulin** * For Rh-negative women --- ## **Post-Evacuation Follow-Up** ### **β-hCG Monitoring** * Weekly until **normal for 3 consecutive weeks** * Then monthly for: * **6 months (partial mole)** * **12 months (complete mole)** ### **Contraception** * Mandatory during follow-up * Combined oral contraceptives are safe --- ## **Gestational Trophoblastic Neoplasia (GTN)** ### **Diagnostic Criteria (FIGO)** * Plateauing β-hCG (±10% for 4 values over 3 weeks) * Rising β-hCG (>10% for 3 values over 2 weeks) * Persistently detectable β-hCG >6 months * Histological choriocarcinoma --- ## **FIGO Staging** | Stage | Description | | ----- | ------------------------------- | | I | Confined to uterus | | II | Extends to pelvis | | III | Lung metastasis | | IV | Other metastasis (brain, liver) | --- ## **WHO Risk Scoring** Low risk: **0–6** High risk: **≥7** --- ## **Chemotherapy** ### **Low-Risk GTN** **Single-agent chemotherapy** #### **Methotrexate** * **Indication:** Low-risk GTN * **Mechanism:** Folate antagonist → inhibits DNA synthesis * **Dose:** * 50 mg IM weekly OR * 0.4 mg/kg/day × 5 days * **Adverse effects:** Stomatitis, hepatotoxicity, myelosuppression * **Contraindications:** Liver disease, renal failure * **Monitoring:** LFTs, CBC * **Counselling:** Avoid alcohol, pregnancy OR #### **Actinomycin-D** * **Mechanism:** DNA intercalation * **Dose:** 1.25 mg/m² IV every 2 weeks * **Adverse effects:** Alopecia, nausea --- ### **High-Risk GTN** **Multi-agent chemotherapy** #### **EMA-CO Regimen** * **Etoposide** * **Methotrexate** * **Actinomycin-D** * **Cyclophosphamide** * **Vincristine** **Indication:** WHO score ≥7 **Cure rate:** >90% --- ## **Specific GTN Types** ### **Choriocarcinoma** * Highly malignant * Early hematogenous spread (lungs, brain) * Very high β-hCG * Extremely chemosensitive ### **PSTT / ETT** * Low β-hCG * Less chemosensitive * **Primary treatment: hysterectomy** --- ## **Complications** * Hemorrhage * Thyrotoxicosis * Pulmonary embolism * Metastasis (lung, brain, liver) * Chemotherapy toxicity --- ## **Prognosis** * Overall cure rate: **>95%** * Fertility preserved in most cases * Future pregnancies usually normal --- ## **Patient Counselling** * Excellent prognosis with treatment * Strict β-hCG follow-up is life-saving * Contraception essential during follow-up * Recurrence risk low but real --- If you want next: * **High-yield MCQs (case-based)** * **FIGO scoring calculator** * **Flowchart-style management** * **HTML/CSS/JS exam notes page** * **Differentiation table (mole vs choriocarcinoma)** Just tell me 👍