Trophoblastic disease

1. Big picture

Gestational trophoblastic disease (GTD) is a spectrum of disorders caused by abnormal proliferation of placental trophoblast after fertilization.

The examiner wants you to connect three things:

Abnormal fertilization
        ↓
Abnormal trophoblastic proliferation
        ↓
High beta-hCG, bleeding, abnormal ultrasound, and risk of malignancy

The most important clinical pattern is:

Early pregnancy bleeding
+
uterus larger than dates
+
very high beta-hCG
+
severe nausea/vomiting
+
“snowstorm” ultrasound
        → hydatidiform mole

The most important management principle is:

Evacuate the uterus
        ↓
Send tissue for histology
        ↓
Follow serial beta-hCG until negative
        ↓
Treat persistent/rising hCG as gestational trophoblastic neoplasia

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