OBCast: Gestational Trophoblastic Disease

Author: Ben Shepherd, MBBS FACEM DRANZCOG (Adv) (@OBCast, Emergency Physician Wollongong & Shoalhaven Hospitals NSW Australia) // Edited by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit); and Manpreet Singh, MD (@MprizzleER)

emDocs is proud to host posts from Ben Shepherd, creater of OBCast. From Ben: “During my emergency medicine specialist training I spent time training towards and working as a rural GP obstetrician. It remains some of the most enjoyable and rewarding time I have spent in medicine. Coming back to emergency medicine it is obvious that my colleagues are often uncomfortable managing pregnancy-related problems, particularly those in the latter stages. The goal of ‘OBcast’ is to provide clear and practical information for ‘the reluctant obstetrician’ (emergency physician, rural GP) and improve confidence and the quality of care these families receive during what is both a stressful and wonderful time of their lives.”

This edition of OBCast gestational trophoblastic disease with a video and pdf download.

Gestational Trophoblastic Disease (GTD)


Gestational Trophoblastic Disease

  • Gestational Trophoblastic Disease (GTD) = group of tumurs of placental origin
  • Incidence ~1:200-1000
    • More common in Asian women (2x more common than non-Asian)
  • Includes:
    • Hydatidiform Mole [Complete and Incomplete]
    • Invasive Mole
    • Gestational choriocarcinoma
    • Placental site trophoblastic tumour (PSTT)
    • Epithelioid trophoblastic tumour (ETT)
  • Gestational Trophoblastic Neoplasia (GTN) = GTD requiring chemotherapy or excisional therapy due to metastases or persistent BhCG


Hydatidiform Mole

  • Can be a cause of common presentations:
    • First trimester PV bleeding
    • Hyperemesis
  • 2 types: Complete Mole and Partial Mole
  • Most are cured by suction evacuation
  • 5-4% partial moles persist
  • 15-25% complete moles persist


GTD Management – Basic Flowchart

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