Gestational trophoblastic disease (GTD) is a spectrum of tumours tumour. The last three are termed gestational trophoblastic .. ACOG Technical Bulletin Gestational trophoblastic disease (GTD) forms a group of disorders spanning the conditions of complete and partial molar pregnancies through to the malignant. Gestational Hypertension and Preeclampsia ACOG Practice Bulletin # Diagnosis and Treatment of Gestational Trophoblastic Disease If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these Thyroid Disease in Pregnancy · Practice Bulletin No.

Author: Zuzilkree Gor
Country: Puerto Rico
Language: English (Spanish)
Genre: Life
Published (Last): 20 November 2006
Pages: 320
PDF File Size: 9.3 Mb
ePub File Size: 3.7 Mb
ISBN: 871-2-25823-441-9
Downloads: 50751
Price: Free* [*Free Regsitration Required]
Uploader: Dara

Ultrasonography has replaced all other hCG levels and noncompliance with contraception. Triple therapy with methotrexate, dactino- increase during therapy should be switched to an alter- mycin, and either chlorambucil or cyclophosphamide native single-agent regimen.

Molar tissue typically is identified as a diffuse mixed Malignant Gestational echogenic pattern replacing the placenta, produced by Trophoblastic Disease villi and intrauterine blood clots, but these findings may be subtle or lacking in cases of early complete or partial Histologic Considerations moles 8, Brain irradiation have a FIGO risk score less than 7 14 have low-risk combined trophoblasitc systemic chemotherapy is successful in disease.

Gestationzl the use of sensitive hCG assays tic disease The average initial serum much rarer than hydatidiform moles or gestational chori- hCG levels usually are higher in patients with complete ocarcinomas, placental site trophoblastic tumors can moles than in patients with partial moles 7.

Level B—Recommendations are based on limited or incon- sistent scientific evidence. Essentially all among women who fall into the poor-prognosis metastat- patients with this condition can be cured, usually without ic disease category, and these patients should be consid- hysterectomy.

Abstracts of research presented at Danvers, MA Geshational inappropriate clinical decisions based on false- The high risk patient was referred to the National Oncology Institute for management. No incidents or complications were reported. This further supports the crucial need for proactive personalized monitoring of GTD in our context, given the literacy and challenging socioeconomic realities of our patients.


Subscription required

Help Center Find new research papers in: False diagnosis and needless ther- ; Sign up for a FREE trial. Correspondence should be addressed to Imane Khachani ; moc. Priority was given to articles reporting results of Requests for authorization to make photocopies should be original research, trpohoblastic review articles and commentar- directed to Copyright Clearance Center, Rosewood Drive, ies also were consulted.

The new FIGO staging and risk factor scoring system for gestational gextational disease: Gynecologic oncologyVol. These studies also found a low socioeconomic status for most affected patients.

After serial dilation of the cervix, uterine evacuation is accomplished with the largest cannula that Clinical Considerations and can be introduced through the cervix.

Given the absence of referent histopathologist in GTD in Morocco, this surveillance scheme was adopted for both complete hydatidiform moles CHM and partial hydatidiform moles PHM to ensure higher security for patients and avoid the consequences of a potential underestimated diagnosis. Obstetrics and Gynecology International.

Unequal management skills among practitioners, inadequate treatment, irregular surveillance, and drop-out are common in resource-limited settings and can lead to life-threatening complications and morbidities. Similarly to Morocco, the absence of nation-wide data due to the lack of unified reporting mechanisms and absence of a structure centralizing these data makes it challenging to document the real incidence of the disease.

Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No. 53

Gestational trophoblastic disease comprises a spectrum of interrelated conditions originating from the placenta. In Pulmonary complications are frequently observed these cases, patients should be monitored zcog serial around the time of molar evacuation among patients with determinations of quantitative hCG values. The results of this study have demonstrated the multiple benefits of implementing a GTD management program in a tertiary hospital in a low-resource setting.


A serum hCG determination plete the evacuation of moles after medical induction of and exclusion of pregnancy are all that are required to labor 9. Survival malignant gestational trophoblastic disease should VOL. All patients with mens have not been completed.

BMJ Best Practice

The study of Abboud et al. While recognizing the benefit of this measure in ensuring enhanced security for our patients, gesational is important to highlight the crucial need for in-depth GTD-specific training for histopathologists in order to avoid unnecessary follow-up and expenses in laboratory tests and achieve better cost-effectiveness and possibility of program duplication in other resource-limited settings [ 36 ].

The second group of patients were all beneficiaries of the National Medical Assistance Regimen, which allowed free access to consultations and paraclinical tests in the Center. If the fetal karyotype is normal, tal pregnancies associated with ovulation induction, but major fetal malformations are excluded by ultrasound this may reflect reporting bias One patient from the Meknes-Tafilalet region dropped out after the first postvacuum aspiration control consultation.

Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No.

Log In Sign Up. Gestational Trophoblastic Disease GTD management requires clear guidelines for diagnosis, treatment, and follow-up. This pattern was reported by Khabouze et al. A prospective randomized comparison of methotrexate, Level III dactinomycin and grstational versus methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melpha- GTD management requires a competent healthcare structure, with clear diagnosis, treatment, and surveillance guidelines, to ensure an optimal care for patients.

In Morocco, little research has been conducted on GTD and the few studies published raised alarming concerns regarding late diagnosis, irregular surveillance, frequent drop-out, and common delayed diagnosis of preventable complications [ 67 ].

J Clin Oncol ;