During pregnancy, gestational trophoblastic disease (GTD) occurs when trophoblastic cells grow abnormally, which surround an embryo and help form the placenta. There are a number of conditions that are associated with GTD, including hydatidiform moles, invasive moles, choriocarcinomas, placental-site trophoblastic tumors, and epithelioid trophoblastic tumors.
Causes
Gestational trophoblastic disease is not fully understood, but it is believed to result from abnormal fertilization and placental development. Risk factors for GTD include:
-
Pregnancy with molars in the past
-
The age of the mother (women younger than 20 or older than 35)
-
Miscarriage or stillbirth history
-
Pregnancy history of GTD
-
Female ethnicity (higher incidence among Asian women)
Symptoms
Gestational trophoblastic disease symptoms can vary depending on the type and stage of the condition. Common symptoms include:
-
Dark brown or bright red bleeding or spotting in the vaginal canal
-
Hyperemesis gravidarum (excessive nausea and vomiting)
-
An enlarged uterus disproportionate to the gestational age
-
Pain or pressure in the pelvis
-
Blood or urine levels of human chorionic gonadotropin (hCG) are elevated
-
Early pregnancy preeclampsia or hyperthyroidism
Diagnosis
Clinical evaluation, imaging studies, and laboratory tests are typically used to diagnose gestational trophoblastic disease. Diagnostic procedures may include:
-
An ultrasound is performed to assess the size and appearance of the uterus as well as any abnormalities in the placenta or gestational sacs.
-
Human chorionic gonadotropin (hCG) hormone levels are typically elevated in women with GTD.
-
The diagnosis of abnormal trophoblastic cells is determined by histopathological examination of tissue samples obtained through suction curettage or biopsy.
Treatment
The treatment for gestational trophoblastic disease depends on the type and stage of the condition, the patient's overall health, and the patient's reproductive goals.
-
To remove abnormal placental tissue from the uterus, suction curettage or dilation and evacuation (D&C) is performed.
-
To destroy cancerous trophoblastic cells and prevent recurrence with drugs such as methotrexate, actinomycin-D, or combination regimens.
-
Women after childbirth who suffer from persistent or recurrent disease may undergo hysterectomy (surgical removal of the uterus).
Prevention
Because gestational trophoblastic disease is not well understood, no specific preventive measures are available to prevent its occurrence. It may be possible, however, to reduce the risk of complications associated with GTD by detecting and managing molar pregnancies early through routine prenatal care and ultrasound screening.
Conclusion
The gestational trophoblastic disease is a rare pregnancy-related disorder that is characterized by abnormal growth of trophoblastic cells. It can result in molar pregnancies, invasive tumors, or metastatic cancer. It is imperative to diagnose GTD early and receive appropriate treatment to achieve favorable outcomes for both mother and fetus. Prenatal care and monitoring play a crucial role in detecting and managing GTD in its early stages, which can improve prognosis and reduce complications.