Gestational trophoblastic disease.
Gestational trophoblastic disease consists of a broad spectrum of conditions ranging from an uncomplicated partial hydatidiform molar pregnancy to stage IV choriocarcinoma with cerebral metastases. Fortunately, with the advent of combination chemotherapy, the patient with advanced-stage disease has a significant chance of achieving complete remission. In addition, several studies have demonstrated that patients with a history of gestational trophoblastic neoplasia do not experience an increased risk of complications with future pregnancies. Patients who have undergone chemotherapy do not seem to experience an increase in the risk for congenital anomalies in their offspring. Patients with a history of hydatidiform molar pregnancy should be advised that they are at increased risk of future molar pregnancies, with a risk of 1% in subsequent gestations after one molar pregnancy and a risk as high as 23% after two molar gestations. Although patients should be reassured regarding their reproductive future, they should be advised to seek prompt medical attention once gestation is suspected so that an early work-up can be initiated if pregnancy is confirmed.
Shapter
A P
AP
Department of Gynecology, Lahey Clinic Medical Center, Burlington, Massachusetts 01805, USA.
McLellan
R
R
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002822:Choriocarcinoma / Q000628:therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000628:therapy*; D007044:Hysterectomy / Q000379:methods; D008727:Methotrexate / Q000008:administration & dosage; D009367:Neoplasm Staging; D011247:Pregnancy; D014594:Uterine Neoplasms / Q000628:therapy*
D003520:Cyclophosphamide; D008727:Methotrexate