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Gestational Trophoblastic Disease (GTD) and Hormone Replacement Therapy
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Gestational Trophoblastic Disease (GTD) and Hormone Replacement Therapy

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@AdorableSavanna

Questions and Answers

What is the condition referred to when there is persistence of GTD after primary treatment?

  • Gestational trophoblastic disease
  • Atypical placental site nodules
  • Gestational trophoblastic neoplasia (correct)
  • Complete mole

    • What is necessary for the diagnosis of complete mole, partial mole, atypical PSN and PSTT/ETT?

  • Persistent elevation of human chorionic gonadotrophin
  • Online support groups
  • Histological confirmation (correct)
  • GTD centres support

    • When can hormone replacement therapy be used for women after GTD?

  • Once hCG levels have returned to normal (correct)
  • Immediately after GTD diagnosis
  • Never, it's not safe
  • Only after GTD centres support is sought

    • What do GTD centres provide to women and their families throughout their GTD journey?

    <p>Individualised support</p> Signup and view all the answers

    What is the malignant potential of atypical placental site nodules?

    <p>Unclear</p> Signup and view all the answers

    Where can online support groups be accessed for GTD?

    <p>molarpregnancy.co.uk</p> Signup and view all the answers

    What type of tumour is very rare and has trophoblastic disease?

    <p>Placental site trophoblastic tumour</p> Signup and view all the answers

    When can exogenous estrogens and other fertility drugs be used?

    <p>Once hCG levels have returned to normal</p> Signup and view all the answers

    What is a characteristic feature of a complete molar pregnancy?

    <p>Absence of fetal tissue</p> Signup and view all the answers

    What is the approximate incidence of GTD in women from Asia in the UK?

    <p>1 in 387 live births</p> Signup and view all the answers

    What is the method of choice for removal of a partial molar pregnancy when the size of fetal parts deters the use of suction curettage?

    <p>Medical removal</p> Signup and view all the answers

    At what age group is the incidence of GTD highest?

    <p>Women aged less than 15 years</p> Signup and view all the answers

    What is the estimated incidence of GTN after a live birth?

    <p>1 in 50 000</p> Signup and view all the answers

    Why is ultrasound guidance during removal and curettage recommended?

    <p>To minimize the chance of perforation</p> Signup and view all the answers

    What is the cure rate of the UK's registration and treatment programme for GTN?

    <p>98-100%</p> Signup and view all the answers

    What is the role of p57 immunohistochemistry staining in the diagnosis of molar pregnancies?

    <p>To distinguish between complete and partial molar pregnancies</p> Signup and view all the answers

    What is recommended following removal of a molar pregnancy?

    <p>Anti-D prophylaxis</p> Signup and view all the answers

    What is the chemotherapy rate for GTN after partial molar pregnancy?

    <p>0.5-1.0%</p> Signup and view all the answers

    What is the minimum standard of care for women with GTN?

    <p>Registration with a GTD centre</p> Signup and view all the answers

    What is a characteristic feature of a partial molar pregnancy?

    <p>Presence of fetal tissue</p> Signup and view all the answers

    What is the method of choice for removal of a complete molar pregnancy?

    <p>Suction curettage</p> Signup and view all the answers

    What database was included in the search for relevant papers for this guideline?

    <p>EMBASE</p> Signup and view all the answers

    Why is suction curettage the method of choice for removal of complete molar pregnancies?

    <p>Because it allows for complete removal of the molar tissue</p> Signup and view all the answers

    What is the time period during which relevant articles were included in the search?

    <p>January 2008 to June 2019</p> Signup and view all the answers

    What is the recommended approach to removing a complete molar pregnancy?

    <p>Avoiding medical removal if possible, irrespective of the agents used</p> Signup and view all the answers

    What is the risk of developing GTN and requiring chemotherapy when medical methods of removal are used compared to surgical removal?

    <p>16-fold higher</p> Signup and view all the answers

    What is the theoretical concern regarding the routine use of potent oxytocic agents?

    <p>They may embolise and disseminate trophoblastic tissue through the venous system</p> Signup and view all the answers

    In which situation can medical removal of a molar pregnancy be used?

    <p>For twin pregnancies where there is a non-molar pregnancy alongside a molar pregnancy</p> Signup and view all the answers

    What is the risk of incomplete removal with medical methods for complete molar pregnancies?

    <p>13-16%</p> Signup and view all the answers

    What is the risk of incomplete removal with medical methods for partial molar pregnancies?

    <p>0.5-1.0%</p> Signup and view all the answers

    What is the current state of evidence regarding the use of ultrasound at the time of uterine removal for GTN?

    <p>There is no published evidence examining its use</p> Signup and view all the answers

    What is the concern related to the use of potent oxytocic agents in the context of molar pregnancy?

    <p>They may lead to adult respiratory distress syndrome</p> Signup and view all the answers

    What is a potential complication associated with the surgical management of molar pregnancy?

    <p>Excessive vaginal bleeding</p> Signup and view all the answers

    Why is the routine use of oxytocic agents, such as ergometrine and misoprostol, theoretically concerning in molar pregnancy?

    <p>They can embolise and disseminate trophoblastic tissue</p> Signup and view all the answers

    In what scenario may oxytocic infusions be indicated despite the risk of tissue embolisation?

    <p>Life-threatening haemorrhage or ongoing bleeding</p> Signup and view all the answers

    What may occur when the myometrium contracts and forces tissue into the venous spaces at the level of the placental bed?

    <p>Trophoblastic tissue dissemination</p> Signup and view all the answers

    What is an indication for urgent surgical management in women with molar pregnancy?

    <p>Heavy or persistent vaginal bleeding causing acute haemodynamic compromise</p> Signup and view all the answers

    What may lead to profound deterioration in the patient with molar pregnancy?

    <p>Tissue embolisation</p> Signup and view all the answers

    What is a potential consequence of tissue embolisation in molar pregnancy?

    <p>Embolic and metastatic disease in the lungs</p> Signup and view all the answers

    Why is it important to weigh up the need for oxytocin infusion against the risk of tissue embolisation in women with molar pregnancy?

    <p>To prevent embolic and metastatic disease</p> Signup and view all the answers

    Study Notes

    Gestational Trophoblastic Disease (GTD)

    • GTD comprises a group of disorders, including complete and partial molar pregnancies, invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT)
    • The malignant potential of atypical placental site nodules (PSNs) remains unclear

    Diagnosis and Incidence

    • Incidence of GTD in the UK is higher in women from Asia (1 in 387 live births) compared to non-Asian women (1 in 752 live births)
    • Incidence of GTD is associated with age at conception, being higher in the extremes of age (women aged less than 15 years, 1 in 500 pregnancies; women aged more than 50 years, 1 in 8 pregnancies)
    • GTN may develop after a molar pregnancy, a non-molar pregnancy, or a live birth
    • The incidence of GTN after a live birth is estimated at 1 in 50,000

    Treatment and Management

    • Hormone replacement therapy may be used once hCG levels have returned to normal
    • Exogenous estrogens and other fertility drugs may be used once hCG levels have returned to normal
    • GTD centers provide individualized support to women and their families throughout their GTD journey
    • Online support groups are available, alongside regular drop-in support groups at designated hospitals
    • The registration of affected women with a GTD center represents a minimum standard of care

    Pathological Features

    • Pathological features of complete molar pregnancies include absence of fetal tissue, extensive hydropic change to the villi, and excess trophoblast proliferation
    • Features of a partial molar pregnancy include presence of fetal tissue, focal hydropic change to the villi, and some excess trophoblast proliferation
    • Ploidy status and immunohistochemistry staining for p57 may help in distinguishing partial from complete molar pregnancies

    Removal of a Molar Pregnancy

    • Suction curettage is the method of choice for removal of complete molar pregnancies
    • Ultrasound guidance during removal and curettage may be of use to minimize the chance of perforation and to ensure that as much tissue as possible is removed
    • Anti-D prophylaxis is recommended following removal of a molar pregnancy
    • Medical removal of a complete molar pregnancy should be avoided if possible
    • The risk of developing GTN and requiring chemotherapy is 16-fold higher when medical methods of removal are used compared to surgical removal

    Complications and Concerns

    • There is theoretical concern over the routine use of potent oxytocic agents because of the potential to embolise and disseminate trophoblastic tissue through the venous system
    • Excessive vaginal bleeding can be associated with surgical management of molar pregnancy

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    Description

    This quiz explores the use of hormone replacement therapy in women with Gestational Trophoblastic Disease (GTD) after hCG levels have returned to normal. It also discusses the impact of GTD diagnosis on women and their families.

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