ENFERMEDAD TROFOBLÁSTICA GESTACIONAL: MOLA HIDATIDIFORME. - Ginecología y Obstetricia -

Dr. Melgar explains that gestational trophoblastic disease (GTN) is a condition characterized by abnormal trophoblast growth and development following abnormal fertilization. It usually has a good prognosis, but has aggressive potential, given its invasiveness and persistence. TYPES OF GESTATIONAL TROPHOBLASTIC DISEASE GTN includes hydatidiform mole and gestational trophoblastic neoplasia (GTN) (which we will discuss in another video). It is a condition with a very low prevalence, around 1 in every 1,000 pregnancies, and is more common in Asia than in Europe or America. RISK FACTORS The most important are maternal age (under 16 or over 40 years of age) and a previous molar pregnancy. If there is a history of repeated molar pregnancies, there is a higher risk of suffering from GTN. MOLAR PREGNANCY Hydatidiform mole: Pregnancy with an anomalous placenta with varying degrees of trophoblastic hyperplasia and villous edema. It is classified as complete or partial, and they are distinct entities from a clinical, morphological, and cytogenetic perspective. There is also an invasive mole, which is the variant capable of infiltrating the myometrium and spreading distantly. COMPLETE MOLE: It usually presents as vaginal bleeding in the second trimester, with an enlarged uterus. Hyperemesis and biochemical hyperthyroidism are sometimes present as well, as are clinically unrelated symptoms. In this case, an empty egg is fertilized by a sperm that then duplicates its DNA, resulting in a diploid androgenetic karyotype, usually 46,XX (10% 46,XY). Rarely, an empty egg is fertilized by two sperm (dyspermia). Serum hCG is greater than 100,000 (90%). PARTIAL MOLE: Symptoms are few, although it may present with vaginal bleeding, subclinical, or incomplete abortion at the end of the first trimester or beginning of the second. The uterus is usually not enlarged and is rarely associated with hyperemesis or biochemical hyperthyroidism. It is almost always formed by an empty ovum, which is fertilized by two sperm, resulting in a triploid karyotype (diandric triploidy, with two paternal chromosomes and one maternal chromosome), usually 69,XXY. INVASIVE MOLE: It usually arises from a complete mole that invades the myometrium and/or uterine vessels. It is not considered a true neoplasia, but is clinically malignant, as it can infiltrate the myometrium and metastasize. DIAGNOSIS The main symptoms are metrorrhagia, hyperemesis, and an enlarged uterus. TRANSVAGINAL ULTRASOUND: This is the technique of choice for making a suspected diagnosis. It is used to assess the presence of an embryo, placental vascularization, and the possibility of ectopic pregnancy. The classic "snowstorm" of a complete mole may not be visible during the first trimester. Promiscuous theca-lutein cysts may appear in up to 50% of cases and disappear spontaneously, even after several months. THE DEFINITIVE DIAGNOSIS IS PATHOLOGICAL (AP): GTD originates from placental trophoblast, which is composed of cytotrophoblast, syncytiotrophoblast, and intermediate trophoblast. DIAGNOSTIC APPROACH TO GTD: When there is clinical suspicion: vaginal bleeding + hyperemesis + enlarged uterus, with an appropriate gynecological examination and compatible ultrasound findings, the following is required: hCG determination. A basic and thyroid profile is also recommended. Uterine evacuation. Histological confirmation. If GTD is confirmed, perform a post-evacuation hCG test. HCG DETERMINATION: If GTD is suspected, a serum hCG test should be performed. Total hCG is recommended, but beta-hCG (more commonly used) can also be used. It is important to use the same test for diagnosis and follow-up. TREATMENT After GTD is suspected, suction curettage will allow for treatment and diagnostic confirmation of the condition. Preferably under ultrasound guidance. FOLLOW-UP: Follow-up is key to diagnosing GTD in a timely manner and starting treatment as soon as possible. It is performed by quantitatively determining serum hCG levels. Related Topics: Liver Disease and Pregnancy: https://www.youtube.com/watch?v=oq4W0... Cholestasis of Pregnancy:    • COLESTASIS INTRAHEPÁTICA DEL EMBARAZO: cau...   Heart Disease and Pregnancy: https://www.youtube.com/watch?v=jdnUl... Postpartum Depression: https://www.youtube.com/watch?v=sjpbU... More information, videos, podcasts, and PDFs at AULAGINECOLOGIA.COM