PREGNANCY TROPHOBLASTIC DISEASE (1).pptx

: Gestational Trophoblastic Disease: An Overview1.

: Understanding, Diagnosing, and Managing GTD.

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Use an engaging visual, such as a microscopic image of trophoblastic tissue, to capture attention59.

Define gestational trophoblastic disease as a group of rare conditions where abnormal trophoblast cells grow in the uterus after conception1.

Explain that GTD originates from the trophoblastic layer of the embryo, which normally develops into the placenta27.

: Briefly introduce the main categories: hydatidiform moles (complete and partial) and gestational trophoblastic neoplasia (GTN)18.

: Highlight that GTD is highly treatable, especially when detected early7.

Mention that early ultrasound detection has improved clinical presentation and decreased morbidity3.

: Describe the normal function of trophoblast cells in connecting the fertilized egg to the uterine wall and forming the placenta17.

Use visuals to illustrate the development of the trophoblast into the chorion and amnion2.

: Explain that in GTD, trophoblast cells grow abnormally, leading to tumors instead of a healthy placenta7.

: Define hydatidiform moles as the most common type of GTD, resulting from abnormal fertilization18.

Explain that it is not a normal pregnancy, and a normal fetus does not form8.

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: Develops when there is a total loss of the mother’s chromosomes and the egg is fertilized by one or two sperm8. No fetal tissue is present8.

: Usually develops when a normal egg is fertilized by two sperm, resulting in a mixture of fetal and abnormal trophoblast tissue8. A fetus may be present but is usually abnormal and cannot develop normally8.

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Uterus is often larger than expected within 10 to 16 weeks gestation2.

Vaginal bleeding1.

Severe nausea and vomiting (hyperemesis gravidarum)2.

Absent fetal movement and fetal heart sounds2.

Vaginal passage of grapelike tissue2.

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Positive pregnancy test with abnormally high levels of hCG (human chorionic gonadotropin)38.

Pelvic ultrasound showing a characteristic "snowstorm" appearance in complete moles or a gestational sac with an abnormal fetus in partial moles2.

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Suction curettage is the most effective treatment for complete and non-viable partial moles6.

Anti-D prophylaxis is recommended post-evacuation if the mother is Rhesus negative6.

Follow-up with hCG monitoring is essential for early diagnosis of gestational trophoblastic neoplasia (GTN)3.

: Define GTN as a malignant form of GTD that can occur after a molar pregnancy, normal pregnancy, miscarriage, or ectopic pregnancy12.

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: A hydatidiform mole that invades the myometrium (muscular layer of the uterus)1.

: A fast-growing, aggressive cancer that develops from trophoblastic cells1. It can metastasize to the lungs, liver, or brain2.

: A rare type of GTN that forms where the placenta attaches to the uterus1. It grows slowly and may appear months or years after a normal

1. TROPHOBLASTIC DISEASE

2. DEVELOPMENT OF THE FERTILISED OVUM After fertilisation has taken place in the ampulla of the fallopian tube , the zygote goes through the tube and continues until it reaches the uterus three to five days later. During this journey, mitotic cellular replication and division takes place, a process called cleavage. Hence the zygote divides into two cells at day 1, then into four at day 2, eight by day 2.5 and by day 3 cluster of 16 cells known as morula is formed. The morula cells are tightly held together in a process called compactation by day 4.

3. DEVELOPMENT OF THE FERTILISED OVUM The morula is then transformed into a blastocyst containing large peripheral cells (trophoblast ) surrounding a fluid cavity called blastocoel/ blastocele, with inner cell mass (embryoblast )at one corner. The blastocyst is composed of 58 cells. The peripheral cells are the trophoblastic cells that will later form the placenta and chorion and the inner cell mass composed of embryoblast cells will form the embryo and amnion.

4. 3. TROPHOBLASTIC DISEASE This refers to a group of disorders characterized by abnormal development of placenta during pregnancy . Causes and pathophysiology The disease starts in the layer of cells called trophoblast that surrounds the embryo. The trophoblastic cells form finger like projections called chorionic villi . The villi grow into the endometrium and later develop into a placenta. In trophoblastic disease, the cells acquire abnormal characteristics and develop into benign or malignant tumors.

5. 3. TROPHOBLASTIC DISEASE Types of trophoblastic disease Hydatidiform moles/ molar pregnancy Invasive mole Choriocarcinoma Placental site trophoblastic tumor Epithelioid trophoblastic tumor

6. 3. TROPHOBLASTIC DISEASE: a) Hydatidiform mole pregnancy (molar pregnancy) It is characterized by chorionic villi that have become swollen with fluid. These chorionic villi grow in clusters that look like bunches of grapes. Molar pregnancy is a benign tumor but can be transformed into malignant tumor. It tend to recur in the subsequent pregnancies There two types of molar pregnancy;

7. 3. TROPHOBLASTIC DISEASE a) Hydatidiform mole pregnancy 1. Complete Hydatidiform mole This develops when one or two sperms fertilize an ovum that has no nucleus (an empty ovum), giving rise to a product of conception that has genetic material only from the father’s sperm . Hence, there is no fetal tissue. Complete molar pregnancy tends to develop into malignant trophoblastic disease.

8. 3. TROPHOBLASTIC DISEASE a) Hydatidiform mole pregnancy 2. Partial Hydatidiform mole This develops when 2 sperms fertilize a normal ovum , the tumors contain some fetal tissue mixed with trophoblastic tissue but the fetus is not viable . However, in very rare cases of partial molar pregnancy, a normal fetus can develop alongside the molar pregnancy . Partial molar pregnancy rarely develop in to malignant trophoblastic disease

9. 3. TROPHOBLASTIC DISEASE a) Hydatidiform mole pregnancy Clinical features Vaginal bleeding in the first trimester Passage of grape like tissues per vaginal Uterine enlargement , usually larger than the estimated gestational age. Severe hyperemesis gravidarum Features of anemia due to bleeding Features of preeclampsia High levels of circulating human chorionic gonadotrophin hormone (hCG).

10. 3. TROPHOBLASTIC DISEASE b) Invasive mole This is a molar pregnancy that has grown into the muscle layer of the uterus (Myometrium). It can follow complete or partial hydatidiform mole . It may metastasize to other body parts especially the lungs. It is associated with life threatening bleeding The risk is high in case of; Complete hydatidiform mole Molar pregnancy that is above 4 months gestation Marked uterine enlargement Age above 40 years History of previous molar pregnancy

11. 3. TROPHOBLASTIC DISEASE c) Choriocarcinoma This is the malignant form of trophoblastic disease. It commonly spreads to other systems including respiratory and nervous. The risk is high following; Complete molar pregnancy Abortion Ectopic pregnancy Normal pregnancy

12. 3. TROPHOBLASTIC DISEASE Diagnosis Health history and physical examination- abdominal enlargement does not much the gestational dates Urine for pregnancy test- positive Blood for hCG assay- Usually very high above 100,000mIU/ml Ultrasound that confirms presence of trophoblastic disease

13. 3. TROPHOBLASTIC DISEASE: Management a) Pregnancy evacuation via manual vacuum aspiration or dilatation and curettage. The procedure may be repeated in case of persistent bleeding and high levels of serum hCG. Give hematinic to treat anemia i.e. ferrous sulphate and folic acid Client follow-up to monitor hCG serum levels fortnightly until the serum level is less than 2 IU/L. The client is then followed up monthly for 6 months to 12 months with monitoring of hCG levels during each visit. Counsel the client to avoid pregnancy until 6-12 months after serum levels fall to normal. Preferably recommend hormonal oral contraceptives and avoid IUCD.

14. 3. TROPHOBLASTIC DISEASE… Advice client to start antenatal care immediately after missing the menstrual period in the subsequent pregnancies. This is because recurrent in the subsequent pregnancies is common. b) Chemotherapy with methotrexate or actinomycin-D or a combination of chemotherapy in case of invasive mole or choriocarcinoma c) Hysterectomy is the treatment method of choice if the client does not want more children, and severe form of invasive mole and choriocarcinoma