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Introduction to early pregnancy loss - trophoblast diseases

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Left: choriocarcinoma. Right: metastatic gestational trophoblastic neoplasia. Image on left only reprinted from: Lurain JR. Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. Am J Obstet Gynecol 2011;204:11-18 with permission from Elsevier.

Gestational trophoblastic disease (GTD) consists of a range of pregnancy-related disorders originating from disordered placental proliferation.

Premalignant disorders include complete and partial hydatidiform mole. Malignant disorders, termed gestational trophoblastic neoplasia (GTN), include invasive mole, choriocarcinoma and placental site trophoblastic tumour.

In the UK, molar pregnancy occurs in around 1–3 per 1000 pregnancies, whereas choriocarcinoma is even rarer (1 in 50 000 deliveries). To improve the management of the condition, there is a national registration scheme in the UK for all women diagnosed with GTN. The nominated UK human chorionic gonadotrophin (hCG) surveillance/molar pregnancy registration centres are:

  • Weston Park Hospital, Sheffield
  • Charing Cross Hospital, London
  • Ninewells Hospital, Dundee

Despite its relative rarity, GTN remains an important disorder for the gynaecologist and other clinicians to recognise because if it is recognised and treated appropriately, it is nearly always curable (cure rate exceeds 98%) with fertility retention.

Learning objectives

When you have completed this tutorial you should:

  • have a comprehensive knowledge of the terminology, epidemiology, genetics, clinical presentation and ultrasound diagnosis of GTD
  • have an awareness of differences in histopathology and genetics in relation to GTD
  • understand the preference for treatment by surgical uterine evacuation
  • understand the need for registration of GTN with trophoblastic screening centre (assuming UK-based practice)
  • have an overview of the indications for chemotherapy for GTD
  • have an overview of FIGO prognostic and anatomical staging systems, low- and high-risk classification and monochemotherapy versus multiple-drug chemotherapy regimens
  • have a comprehensive understanding of contraception and advice regarding future pregnancies in women with previous molar disease and how this varies if chemotherapy was required

Last updated: 23/08/2011 (tutorial was revised and updated by Dr Rajesh Varma)

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