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Specific Management of PPH
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
This condition is defined as the occurrence of excessive or abnormal bleeding from the uterus after 24 hours and till 12 weeks postpartum. It occurs in about 0.5%–1% of pregnancies. The causes include endometritis, retained products, placental polyp, gestational trophoblastic disease, placental site trophoblastic tumour, and arteriovenous malformation (AVM). Rarely coagulation abnormality due to evolving liver disorder, anticoagulant intake, immunologic thrombocytopaenia, haematological malignancies, and fibroid polyp needs to be kept in mind.
Gestational trophoblastic disease
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Fieke E M Froeling, Michael J Seckl
Gestational trophoblastic disease (GTD) is an uncommon complication of pregnancy. An average consultant obstetrician may deal with only one new case every second year. The term gestational trophoblastic disease describes a group of inter-related diseases, including the pre-malignant disorders of partial and complete hydatidiform mole (PHM and CHM) and the malignant diseases of invasive mole, choriocarcinoma and the rare placental site trophoblastic tumour/epithelioid trophoblastic tumour (PSTT/ETT). The malignant diseases are also collectively named gestational trophoblastic neoplasia (GTN). Although persistent GTD most commonly follows a molar pregnancy, it can be seen after any type of gestation, including term pregnancy, abortion and ectopic pregnancy. Gestational trophoblastic tumours produce hCG which is important in the diagnosis, management and follow-up of these patients, providing an example of an 'ideal' tumour marker. The first complete responses to methotrexate chemotherapy were described in the 1950s, and presently almost 100 percent of patients are cured.
Uterine Swellings
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
This is an abnormal proliferation of trophoblastic tissue with an incidence of 1 per 714 live births in the UK. Gestational trophoblastic disease covers a spectrum of diseases, including complete and partial hydatidiform mole and the malignant conditions of invasive mole, choriocarcinoma, and placental site trophoblastic tumour. The presenting symptoms and signs include first-trimester bleeding, hyperemesis, excessive uterine enlargement, and early failed pregnancy. Rarer presentations include hyperthyroidism, early onset pre-eclampsia, and abdominal distention due to theca lutein cysts. Ultrasound examination is helpful in making a pre-evacuation diagnosis, but the definitive diagnosis is made by the histological examination of the products of conception. An excessive amount of beta-human chorionic gonadotrophin (β-HCG) is produced, providing a ‘tumour marker’ to monitor regression or progression. Management of choice for molar pregnancy is suction curettage. All women diagnosed with molar pregnancy should be registered at one of the three trophoblastic treatment and screening centres (Charing Cross Hospital in London, Weston Park Hospital in Sheffield, and Ninewells Hospital in Dundee). Hydatidiform mole precedes choriocarcinoma in 50 per cent of cases (Fig. 2). This condition is highly chemosensitive and, when managed appropriately, has an excellent prognosis even in the presence of metastatic disease.
Diffuse large B-cell lymphoma of the endometrium: an unusual site for primary presentation
Published in Southern African Journal of Gynaecological Oncology, 2019
The clinical differential diagnosis in a female of reproductive age who presents with abnormal bleeding includes both cervical and endometrial pathology. Cervical causes of bleeding encompass cervicitis including tuberculosis, schistosomiasis and viral warts. In addition, squamous cell carcinoma and adenocarcinoma must be considered. Endometrial causes of bleeding include endometritis, endometrial polyps, submucosal or pedunculated leiomyomas. Despite the patient being of reproductive age, an endometrial carcinoma should be considered in the differential diagnosis. Exogenous hormones in contraceptives or endogenous oestrogen-producing ovarian tumours may also present with abnormal bleeding. Furthermore, gestational trophoblastic neoplasias such hydatidiform mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid trophoblastic tumour must be included in the clinical differential diagnosis.
Caesarean scar pregnancy: time to explore indications of the caesarean sections?
Published in Journal of Obstetrics and Gynaecology, 2019
Muzibunnisa A. Begam, Hisham Mirghani, Wafa Al Omari, Howaida Khair, Hassan Elbiss, Tahira Naeem, Sultan M. Salahudeen
The diagnosis was delayed for four patients (44.4%). The outcome was uneventful for two patients (Cases 3 and 4) in which the pregnancy was non-viable. However, two patients (Cases 6 and 7) required hysterectomy, due to delayed diagnosis (Table 1). The first was due to intractable bleeding at 19 weeks of gestation, and the second was for the misdiagnosis of the sarcoma/choriocarcinoma/placental site trophoblastic tumour (PSTT). CSP was then diagnosed by histopathological examination (Figures 4 and 5).