Gestational trophoblastic disorders
Describes a spectrum of disorders originating from the placental trophoblast:
Complete hydatidiform mole
Benign tumour of trophoblastic material. Occurs when an empty egg is fertilized by a single sperm that then duplicates its own DNA, hence the all 46 chromosomes are of paternal origin
Features
Management
Around 2-3% go on to develop choriocarcinoma
In a partial mole a normal haploid egg may be fertilized by two sperms, or by one sperm with duplication of the paternal chromosomes. Therefore the DNA is both maternal and paternal in origin. Usually triploid - e.g. 69 XXX or 69 XXY. Fetal parts may be seen
*hCG can mimic thyroid-stimulating hormone (TSH)
- complete hydatidiform mole
- partial hydatidiform mole
- choriocarcinoma
Complete hydatidiform mole
Benign tumour of trophoblastic material. Occurs when an empty egg is fertilized by a single sperm that then duplicates its own DNA, hence the all 46 chromosomes are of paternal origin
Features
- bleeding in first or early second trimester
- exaggerated symptoms of pregnancy e.g. hyperemesis
- uterus large for dates
- very high serum levels of human chorionic gonadotropin (hCG)
- hypertension and hyperthyroidism* may be seen
Management
- urgent referral to specialist centre - evacuation of the uterus is performed
- effective contraception is recommended to avoid pregnancy in the next 12 months
Around 2-3% go on to develop choriocarcinoma
In a partial mole a normal haploid egg may be fertilized by two sperms, or by one sperm with duplication of the paternal chromosomes. Therefore the DNA is both maternal and paternal in origin. Usually triploid - e.g. 69 XXX or 69 XXY. Fetal parts may be seen
*hCG can mimic thyroid-stimulating hormone (TSH)