Lecture Quiz: SBAs and EMQs on Gestational Trophoblastic Disease

A 28-year-old woman is undergoing follow-up after evacuation of a complete molar pregnancy. Her serum hCG levels are still elevated. She wishes to start a form of highly effective contraception. What is the most appropriate management?

A 28 year old woman treated for gestational trophoblastic neoplasia (GTN) following a complete molar pregnancy has completed chemotherapy and has normal hCG levels. She asks when she can safely conceive. What is the most appropriate advice?

A 42 year old woman has surgical management of a complete molar pregnancy and subsequently requires single agent chemotherapy treatment with methotrexate.  She Para 2, having had two previous vaginal births, and she has no other significant past medical history. During follow up, she reports troublesome vasomotor menopausal symptoms and asks about hormone replacement therapy (HRT).  Her hCG levels are normal but she remains under follow up with the regional Gestational Trophoblastic Disease Centre.  What is the most appropriate management?

What is the estimated incidence of gestational trophoblastic disease in the UK?

What is the estimated incidence of gestational trophoblastic disease after a live birth?

What is the most common presentation of molar pregnancy?

What is the risk of needing chemotherapy following a complete molar pregnancy?

What is the risk of needing chemotherapy following a partial molar pregnancy?

A 30 year old woman has surgical management for a missed miscarriage at 10 weeks gestation but represents 3 weeks later with ongoing vaginal bleeding and a positive pregnancy test.  What is the incidence of unrecognised gestational trophoblastic disease prior to removal?

A 30 year old woman is treated on two occasional with methotrexate for presumed pregnancy of unknown location.  Serial ultrasound have not shown any evidence of intra-uterine or extra-uterine pregnancy but she has persistently elevated hCG levels on follow-up and is referred to the regional Gestational Trophoblastic Disease Centre for ongoing management. Which of the following is not a potential cause of elevated hCG?

A 26 year old woman has surgical removal of a complete pregnancy and her hCG levels normalise within 56 days.  She is considering trying for to conceive and asks regarding the risk of recurrence. What is the risk of further molar pregnancy?

Which of the following do not require registration with a Gestational Trophoblastic Disease Centre?

A 37-year-old woman presents to the gynaecology clinic with a 4-month history of irregular vaginal bleeding. She delivered a healthy baby 18 months ago and has had normal menstrual cycles until recently. She reports no pelvic pain, weight loss, or systemic symptoms. A pregnancy test is weakly positive. Serum hCG is mildly elevated at 180 IU/L. Transvaginal ultrasound shows a heterogeneous intrauterine lesion confined to the myometrium without evidence of extrauterine spread. Histological examination following uterine curettage reveals infiltration of the myometrium by intermediate trophoblastic cells, with absence of chorionic villi, consistent with placental site trophoblastic tumour. She is referred to a specialist Gestational Trophoblastic Disease centre. Further investigations including CT scan of the chest, abdomen, and pelvis show no evidence of metastatic disease. Based on findings, she is diagnosed with Stage I placental site trophoblastic tumour (disease confined to the uterus). What is the most appropriate management?

A 29-year-old woman presents to the early pregnancy unit at 10 weeks’ gestation with vaginal bleeding, excessive nausea, and lower abdominal discomfort. She reports that her symptoms have been more severe than in her previous pregnancy. On examination, her uterus is larger than expected for gestational age. Ultrasound demonstrates a “snowstorm” appearance with no identifiable fetus, consistent with a complete molar pregnancy. She undergoes suction evacuation, and histology confirms the diagnosis. She is registered with a specialist trophoblastic disease centre and commenced on fortnightly serum hCG monitoring. Her hCG levels decline steadily but remain detectable beyond 8 weeks post-evacuation. At 10 weeks post-evacuation, her hCG finally returns to normal. What is the recommended duration of follow-up?

A 26-year-old woman (Gravida 2, Para 1) presents at 11 weeks’ gestation with light vaginal bleeding and mild lower abdominal discomfort. She reports that her pregnancy symptoms have been less pronounced than expected. Transvaginal ultrasound demonstrates an irregular gestational sac with a non-viable fetus and areas of cystic change within the placenta, suggestive of a partial molar pregnancy. She undergoes surgical evacuation of the uterus. Histological analysis confirms a partial hydatidiform mole. She is referred to a specialist gestational trophoblastic disease centre and enrolled in follow-up. Fortnightly serum hCG measurements are arranged. Her hCG levels decline steadily and return to normal within 4 weeks. What is the recommended duration of follow-up?