Gestational Trophoblastic Disease (GTD) – USMLE Step 2 CK

by / Wednesday, 23 June 2010 / Published in OB/GYN

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GTD is another term for a hydatiform mole.

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How do we suspect this?

  1. Vaginal Bleeding (may cause anemia)
  2. beta-hCG is very high (may cause hyperemesis gravidarum – which is pathological morning sickness)
  3. Size/Date discrepency (the uterus will be bigger than it should be)
  4. Hypertension develops before 20 weeks
  5. Adnexal mass (a theca-lutein cyst due to hCG overstimulation)
  6. No fetal heart tones present
  7. Hyperthyroidism (beta-hCG and TSH are biochemically identical)

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Diagnosis:

1st – Do a sonogram

2nd – Notice a “snow-storm” pattern on ultrasound

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Treatment:….

Suction curettage of the uterus

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Follow-up of Patient:

  1. Serial beta-hCG weekly for 10-20 weeks
  2. 20% of patients will get an increase in beta-hCG, known as “persistent GTD”

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PERSISTENT GTD/CHORIOCARCINOMA…..

If everything is negative, we consider this “non-metastatic” – this holds a good prognosis

If metastatic, check for a good or poor prognosis

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Metastatic disease reveals a poor prognosis if:

  • Metastasis to the liver or brain
  • If hCG is >40,000
  • If it is more than 4 months post-pregnancy

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