Gestational Trophoblastic Disease (GTD). Molar pregnancy. Hydatidiform mole. RCOG guideline. MRCOG.

UPDATE: The incidence of GTN quoted in this video (1 in 50,000 live births) is an underestimate. Recent studies suggest the incidence of GTN to be around 1 in 5,000 live births.
RCOG Green Top Guideline: Gestational Trophoblastic Disease (GTD) for the MRCOG. MRCOG Mastery in 10 Questions! A deep dive into the RCOG Green Top Guideline on GTD, covering partial molar pregnancy, complete molar pregnancy, invasive mole, choriocarcinoma, placental site trophoblastic tumour, epitheliod trophoblatsic tumour, hydatidiform mole, chemotherapy, epidemiology, genetics, diagnosis, treatment, follow-up and more!

[@attiaazizkhan8878]

Dr Arri u are one of the most influential mentor.i love ur videos and i hope u make more n more.
U make us learn complex guidelines with so much ease.thank u

[@Prof_Arri_MRCOG]

Thank you, Attia... we really appreciate your comment 🙏🏽 ❤️

[@geethaezhilrajan8695]

Excellent class sir.

[@Prof_Arri_MRCOG]

Thank you 😊

[@sadiaalim2185]

Amazing

[@user-dl1qn3ib9k]

I have just been diagnosed with persistent GTD. I was using implant for a year as I had my baby and wanted to wait. Once I taken my implant out… I fell pregnant. My scan showed molar pregnancy. My report came back as a partial molar.
One month later I haemorrhaged and was rushed to Russel Halls Hospital then transferred to Charring Cross.
Now I’m on methatroxate.
Was my risk higher at partial molar because I convinced straight after taking my implant?

[@drmahparabilqees3618]

Love and respect from Pakistan 😍😍😍

[@Prof_Arri_MRCOG]

Thank you 😊

[@foujiasharmin9733]

Thank a lot sir. I have a question. Benign GTD when transferred to gtn , it is diagnosed by hcg level ,no need to do histopathology , but when malignant GTD occur after term pregnancy ,how it should diagnosed ? Only hcg or tissue diagnosis is necessary .

[@Prof_Arri_MRCOG]

Hello, good question :) If there is persistent HCG after term birth, we will need to investigate why. The investigations will include pelvic ultrasound, chest x-ray, and other tests (e.g. CT) as necessary. This will help to identify the source of persistent hCG. Once the source is identified, a histology of it will be needed. So, you will have a histologically diagnosed GTD.

[@shahlatufail6]

Is there any role of OCP in GTD

[@Prof_Arri_MRCOG]

OCP can be used after hCG has become normal.

[@karanthkl61]

Contraception ?

[@Prof_Arri_MRCOG]

Barrier methods until hCG is normal. Once hCG is normal COC can be used.

[@محمدجبريل-م2ق]

Thanks sir

[@Prof_Arri_MRCOG]

Welcome

[@karanthkl61]

From normalisation of hcg ( . is it 3 consecutive weekly/ fortnightly hcg) then follow up for 6 months ( ? monthly or fornightly)
FSRH says ocps cn be started from evacuation
Pl your thoughts above issues

[@Prof_Arri_MRCOG]

The practice varies even within the GTD centres in the UK. Normalisation of hCG is generally taken to be 2 normal hCGs 4 weeks apart. COCs to be used from normalisation of hCG; until then recommend barrier method.

[@karanthkl61]

@@Prof_Arri_MRCOG Tq u

[@gloriaappiah6319]

@PROf_Arri_MARCOG I was recently i miscarry blighted ovum. DnC was done suction and evacuation was done. Pathology was No trophoblastic Cells or chorionic villi. Methotrexate injection was given because bhcg was 16680.0
Is getting a hysterectomy a good idea. It has invaded into the endometrium 😢