Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- primeiro trimestre da gestação
- sangramento vaginal
- tamanho uterino incomum para a idade gestacional
Other diagnostic factors
- pré-eclâmpsia de início precoce
- dispneia e desconforto respiratório
- náuseas e vômitos intensos
- taquicardia, tremor, insônia e diarreia
- palidez
- dor pélvica
- sangramento uterino
Risk factors
- extremidades etárias maternas
- gravidez molar prévia
- gordura e caroteno reduzidos na dieta
Diagnostic investigations
1st investigations to order
- exame histológico do tecido placentário
- gonadotrofina coriônica humana (hCG) sérica
- ultrassonografia pélvica
Investigations to consider
- Hemograma completo
- tempo de protrombina (TP), tempo de tromboplastina parcial (TTP) séricos
- perfil metabólico sérico
- hormônio estimulante da tireoide (TSH) sérico
- tipagem sanguínea com rastreamento de anticorpos
- radiografia torácica
Treatment algorithm
gravidez molar única: pacientes que desejam manter a fertilidade
gravidez molar única: pacientes que não desejam manter a fertilidade
feto gêmeo viável: interrupção eletiva não desejada
feto gêmeo viável: interrupção eletiva
após o manejo inicial: alto risco de neoplasia trofoblástica gestacional com conclusão do acompanhamento improvável
Contributors
Authors
Antonio Braga, MD
Associate Professor
Department of Obstetrics and Gynecology
Rio de Janeiro Federal University
Department of Maternal Child
Fluminense Federal University
Rio de Janeiro
Brazil
Disclosures
AB is an author of references cited in this topic.
Kevin M. Elias, MD
Assistant Professor
Brigham and Women’s Hospital
Dana Farber Cancer Institute
New England Trophoblastic Disease Center
Division of Gynecologic Oncology
Department of Obstetrics, Gynecology and Reproductive Biology
Harvard Medical School
Boston
MA
Disclosures
KME has been a paid consultant for AOA Dx and received research support from Aspira Women’s Health and Abcam, Inc. KME is an author of references cited in this topic.
Neil S. Horowitz, MD
Associate Professor
Brigham and Women’s Hospital
Dana Farber Cancer Institute
New England Trophoblastic Disease Center
Division of Gynecologic Oncology
Department of Obstetrics, Gynecology and Reproductive Biology
Harvard Medical School
Boston
MA
Disclosures
NSH is an author of references cited in this topic.
Ross S. Berkowitz, MD
William H. Baker Professor of Gynecology
Brigham and Women’s Hospital
Dana Farber Cancer Institute
New England Trophoblastic Disease Center
Division of Gynecologic Oncology
Department of Obstetrics, Gynecology and Reproductive Biology
Harvard Medical School
Boston
MA
Disclosures
RSB is an author of references cited in this topic.
Acknowledgements
Dr Ross S. Berkowitz, Dr Kevin M. Elias, Dr Neil S. Horowitz, and Dr Antonio Braga would like to gratefully acknowledge Dr John Soper and Dr Emma Rossi, previous contributors to this topic. JS and ER declare that they have no competing interests.
Peer reviewers
Jane Stewart, PhD, MSc
Consultant Gynecologist
Subspecialist in Reproductive Medicine
Newcastle Fertility Centre at Life
Bioscience Centre
International Centre at Life
Newcastle upon Tyne
UK
Disclosures
JS declares that she has no competing interests.
Philip Savage, PhD, FRCP
Consultant in Medical Oncology
Department of Medical Oncology
Charing Cross Hospital
London
UK
Disclosures
PS declares that he has no competing interests.
Aparna Sundaram, DO, MBA, MPH
Physician Consultant
Preventive Medicine
Private Practice
Atlanta
GA
Disclosures
AS declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Horowitz NS, Eskander RN, Adelman MR, et al. Epidemiology, diagnosis, and treatment of gestational trophoblastic disease: A Society of Gynecologic Oncology evidenced-based review and recommendation. Gynecol Oncol. 2021 Dec;163(3):605-13.Full text Abstract
Ngan HYS, Seckl MJ, Berkowitz RS, et al. Diagnosis and management of gestational trophoblastic disease: 2021 update. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(suppl 1):86-93.Full text Abstract
Tidy, J, Seckl, M, Hancock, BW, on behalf of the Royal College of Obstetricians and Gynaecologists. Management of gestational trophoblastic disease. BJOG 2021;128: e1-e27.Full text
Lok C, van Trommel N, Massuger L, et al. Practical clinical guidelines of the EOTTD for treatment and referral of gestational trophoblastic disease. Eur J Cancer. 2020 May;130:228-40. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hiperêmese gravídica
- Aborto espontâneo
- Gestação múltipla
More DifferentialsGuidelines
- Diagnosis and treatment of gestational trophoblastic disease
- Epidemiology, diagnosis, and treatment of gestational trophoblastic disease
More Guidelines
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