WHAT IS GESTATIONAL TROPHOBLASTIC DISEASE?

Gestational Trophoblastic Disease, existing in many terms like Hydatidiform Mole, is a condition associated with second-trimester bleeding. It is an abnormal proliferation and degeneration of the trophoblastic villi. As the cells degenerate, they become filled with fluid and appear as clear fluid filled, grape-sized vesicles. With this condition, the embryo fails to develop beyond a primitive start. Such structures must be identified because they are associated with choriocarcinoma, a rapidly metastasizing malignancy. The incidence of gestational trophoblastic disease is approximately 1 in every 1,500 pregnancies. Two types of molar growth can be identified by chromosomal analysis: Complete Mole: All trophoblastic villi swell and become cystic. If an embryo forms, it dies early at only 1 to 2 mm in size, with no fetal blood present in the villi. On chromosomal analysis, although the karyotype is anormal 46XX or 46XY, this chromosome component was contributed only by a father or an empty ovumwas fertilized and the chromosome material was duplicated

Partial Mole: With a partial mole, some of the villi form normally. The syncytiotrophoblastic layer of the villi, however, is swollen and misshapen. A macerated embryo of approximately 9 weeks; gestation may be present in the villi. A partial mole has 69 chromosomes (a triploid formation in which there is three chromosomes instead of two for every pair, one set supplied by an ovum that apparently was fertilized by two sperm or an ovum fertilized by one sperm in which meiosis or reduction division did not occur). This could also occur if one set of 23 chromosomes was supplied by one sperm and an ovum did not undergo reduction division supplied 46 (see Fig. 2). In contrast to complete moles, partial moles rarely lead to choriocarcinoma.

III. PREDISPOSING FACTORS

A. Diet: Low CHON and low Vitamin A (carotene) intake. B. Age: Women older than 35 years. GTD is higher toward the beginning and toward the end of child bearing period. It is ten times more in women who are 45 years old and beyond. C. Race: Asian heritage. Molar pregnancy has no racial or ethnic predilection, although Asian countries show a rate 15 times higher than the US rate. IV . SIGNS AND SYMPTOMS A. Symptoms: 1. amenorrhea 2. exaggerated symptoms of pregnancy especially vomiting 3. symptoms of preeclampsia that may be present as headache and edema 4. vaginal bleeding as the main complaint; due to the separation of vesicles from the uterine wall and there may be blood-stained, watery discharge (the watery part is from the ruptured vesicles) -like discharge may occur brownish because it is retained for sometime inside the uterine cavity. 5. abdominal pain: may be dull-aching due to rapid distension of uterine by mole or by concealed hemorrhage; colicky due to start of expulsion 6. ovarian pain due to stretching of ovarian capsule or complication in the cystic ovary as torsion B. Signs: 1. preeclampsia develops in 20 - 30 % cases, usually before 20 weeks AOG 2. pallor indicating anemia may be present 3. hyperthyroidism develops in 3-10% of cases manifested by enlarged thyroid gland and tachycardia (due to chorionic thyrotropin secreted by the trophoblast and hCG also has a thyroid-stimulating effect) V. PATHOPHYSIOLOGY