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Neoplasia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The term “gestational trophoblastic disease” comprises a wide variety of pathologic entities, from the benign hydatidiform mole to the highly malignant choriocarcinoma. Hydatidiform mole has been observed since the era of Hippocrates. Richardson and Hertig provided the first account of a hydatid mole in 1638, while in 1827 the midwife Bolvin was the first to ascribe moles as products of gestational origin. In 1895, Felix Morchand finally demonstrated that hydatidiform moles and their malignant sequelae derived from trophoblast, but his concept was not widely accepted until 1903 (158,159).
Investigations, treatment and management
Published in Janetta Bensouilah, Pregnancy Loss, 2021
Complete moles typically cause abnormal vaginal bleeding in the first trimester, whereas partial moles usually present as a missed miscarriage during the first or early second trimester. Most cases will only be diagnosed following an ERPC for a missed miscarriage, and histological findings reveal the mole. Although gestational trophoblastic disease is a very rare complication, some cases can become malignant, and follow-up care is important in all cases. Women are followed up for 6 months following the diagnosis, and in the very unlikely event of malignancy, chemotherapy will be offered.
Miscarriage and Gestational Trophoblastic Disease
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
The development of high-resolution transvaginal sonography has had a significant impact on the management of early pregnancy complications. The accuracy of diagnosis of first-trimester miscarriage allows women to receive treatment options and counseling at earlier gestations. The detection of gestational trophoblastic disease during early pregnancy scanning allows for prompt initiation of treatment and referral to specialist centers.
Current chemotherapeutic options for the treatment of gestational trophoblastic disease
Published in Expert Opinion on Pharmacotherapy, 2023
Antonio Braga, Gabriela Paiva, Cassia Juliana Cattai, Kevin M. Elias, Neil S. Horowitz, Ross S. Berkowitz
The cure rate of patients with low-risk GTN is exceptional, even with metastatic disease, approaching 100% [29]. When adjusting for the WHO/FIGO risk score, the relative risk of death when patients initiate care outside of a reference center is increased to 12.2 for low-risk GTN and 28.3 for high-risk GTN [9]. Therefore, GTN treatment should ideally be lead at Reference Centers [29]. They offer experience in the interpretation of hCG results, skilled multiprofessional teams and facilities equipped to perform multiple and complex treatments, involving chemotherapy, surgery, and/or radiation therapy [30,31]. Centralization of cases of gestational trophoblastic disease is important not only for clinical management but also for histopathological review, since pathologists linked to referral centers have clearly been shown to improve diagnoses of trophoblastic diseases, with a potential impact on disease remission.
Quadruplet Pregnancy with Complete Mole and Three Viable Fetuses
Published in Fetal and Pediatric Pathology, 2022
Cem Yener, N. Cenk Sayın, Fatma Elif Usturalı Keskin, Esra Altan, Sinan Ateş, Füsun Varol
The hydatidiform mole is the most common form of gestational trophoblastic disease and is classified on the basis of pathology and genetic studies as complete or partial [1]. A complete mole is diploid and paternally derived, while a partial mole is mostly triploid. Complete moles are characterized by a marked proliferation of villous trophoblasts associated with diffuse hydatidiform swelling of chorionic villi. Complete moles do not contain any fetal tissue, partial moles contain fetal tissue and focal hydatidiform swelling of chorionic villi, focal trophoblastic hyperplasia, scalloping of chorionic villi and trophoblastic stromal inclusions [2]. The frequency of hydatidiform moles in pregnancies varies between 0.6 and 1.2 per 1000 pregnancies. The frequency of a twin pregnancy with complete hydatidiform mole and co-existing fetus is estimated to be 1 in 22,000–100,000 pregnancies [2, 3]. As triplets and quadruplets are less frequent, the likelihood of one being a molar pregnancy is nearly unique.
Placenta accreta spectrum disorders in the first trimester: a systematic review
Published in Journal of Obstetrics and Gynaecology, 2022
Julieth Alexandra Guzmán López, Luz Ángela Gutiérrez Sánchez, Gabriel David Pinilla-Monsalve, Ilan E. Timor-Tritsch
PAS disorders were diagnosed during hospitalisation for miscarriage/abortion in 41 (74.54%). Information regarding the type of condition was provided in 38 cases: 27 (71.05%) missed miscarriages, 4 (10.52%) incomplete miscarriages, and 7 (18.42%) elective abortions. Drug-induced miscarriage was performed in 5 out of 41 (12.19%) cases with prostaglandin analogues, and invasive procedures were performed in 39 (95.12%), including curettage (n = 37), suction (n = 1), and the use of laminaria (n = 1). Post-procedural haemorrhage, reported as massive, occurred in approximately half of the cases (24/41, 58.53%). The most common differential diagnosis was a gestational trophoblastic disease (n = 9, 16.36%), which was suggested in one-third of these patients by imaging findings of an intrauterine mass with symptoms presenting several weeks after curettage (Brahma et al. 2007; Ju and Kim 2007; Boute et al. 2010). Uterine rupture (n = 5, 9.09%) and retained products of conception (n = 4, 7.27%) were also considered.