Glossary

Term · Loss and Complications

gestational trophoblastic disease

Also: GTD, trophoblastic disease

A group of rare conditions in which abnormal placental tissue grows after conception, detected by a pregnancy hormone level that stays high. Most are treatable.

In plain words

Gestational trophoblastic disease is a group of rare conditions that start in the tissue that becomes the placenta. Some are benign growths, such as a molar pregnancy. Others can invade the uterus or spread, and these are called gestational trophoblastic neoplasia. Doctors follow the disease with the pregnancy hormone . If hCG stays high or keeps rising after a pregnancy ends, a clinician will look for retained tissue, an , or this disease. Blood tests are often repeated for weeks after a loss or molar pregnancy. Most cases respond well to treatment, and the chance of future pregnancy is generally good. Symptoms can include bleeding or pelvic pain, though some people have none.

The deeper version

Gestational trophoblastic disease comprises hydatidiform mole, complete or partial, invasive mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelioid trophoblastic tumor. Diagnosis and surveillance rely on serial quantitative beta-hCG, which should fall steadily after evacuation of a mole or a pregnancy loss. A plateau or rise triggers imaging and consideration of persistent disease. Complete moles are typically androgenetic, with paternal-only chromosomes, while partial moles are often triploid. The FIGO Gynecologic Oncology Committee guidelines (Ngan and colleagues, International Journal of Gynecology and Obstetrics, 2018) set out risk scoring and treatment pathways, with low-risk disease commonly managed by single-agent chemotherapy and higher-risk disease by multiagent regimens. ACOG Practice Bulletin 53 (2004) covers the same ground for US practice. The controversy concerns the thresholds for diagnosing persistent disease and the reliability of surveillance after partial moles.

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Sources

  • Ngan HYS and colleagues (FIGO Gynecologic Oncology Committee) — FIGO guidelines for gestational trophoblastic disease. International Journal of Gynecology and Obstetrics, 2018
  • American College of Obstetricians and Gynecologists — Practice Bulletin 53: Diagnosis and treatment of gestational trophoblastic disease (2004)

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