Gestational trophoblastic disease: The Daily PANCE Blueprint

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Gestational trophoblastic disease: The Daily PANCE Blueprint

A 38-year-old G1PO female at 16 weeks gestation presents to the clinic due to 2 days of relatively light vaginal bleeding. Her vitals are normal. On exam, this is no adnexal or abdominal tenderness, but the uterus is palpable and larger than expected for 16 weeks. On pelvic exam, you note dark blood in the vaginal vault. You check a serum B-hCG which is 140,000 mIU/mL. Her hemoglobin is 10 mg/dL. What is the best diagnostic test?

A. Thyroid ultrasound
B. Chorionic villus sampling
C. Transvaginal ultrasound
D. MRI of the abdomen/pelvis
E. Serum B-hCG monitoring only

Answer and topic summary

The answer is C. Transvaginal ultrasound

Gestational trophoblastic neoplasia (GTN) refers to basically a group of disorders that occur due to inappropriate proliferation of trophoblastic tissue. It includes hydatidiform moles (HM), which include complete HM and partial HM. Complete moles are diploid, and incomplete moles are triploid. It’s important to note that complete moles have an increased risk of cancer potential and usually have marked elevation in hCG. Risk factors include prior molar pregnancy and extremes of maternal age. Clinical features are vaginal bleeding with a positive pregnancy test, pelvic pain/pressure, or uterus size greater than expected for gestational age. Work-up includes hCG levels, RhD typing, and antibody screening, and pelvic ultrasound. Treatment is uterine evacuation (D&C).

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Reproductive System ⇒ Complicated Pregnancy ⇒ Gestational trophoblastic disease

Also covered as part of the Women's Health Rotation topic list

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