gestational trophoblastic diseases(gtds) 教学 讲义.pptVIP

FIGO Staging System for Gestational Trophoblastic Tumors Stage Description Ⅰ Limited to uterine corpus Ⅱ Extends to the adnexae, outside the uterus, but limited to the genital structures Ⅲ Extends to the lungs with or without genital tract Ⅳ All other metastatic sites Substages assigned for each stage as follows: A: No risk factors present B: One risk factor C: Both risk factors Risk factors used to assign substages: 1. Pretherapy serum hCG 100,000 mlU/ml 2. Duration of disease 6 months FIGO Staging System for Gestational Trophoblastic Tumors Signs and Symptoms of Complete Hydatidiform Mole Vaginal bleeding Hyperemesis ( severe vomit) Size inconsistent with gestational age( with no fetal heart beating and fetal movement) Preeclampsia Theca lutein ovarian cysts Signs and Symptoms of Partial Hydatidiform Mole Vaginal bleeding Absence of fetal heart tones Uterine enlargement and preeclampsia is reported in only 3% of patients. Theca lutein cysts, hyperemesis is rare. Diagnosis of hydatidiform mole Quantitative beta-HCG Ultrasound is the criterion standard for identifying both complete and partial molar pregnancies. The classic image is of a “snowstorm” pattern The most common symptom of a mole is vaginal bleeding during the first trimester however very often no signs of a problem appear and the mole can only be diagnosed by use of ultrasound scanning. (rutting check) Occasionally, a uterus that is too large for the stage of the pregnancy can be an indication. NOTE: Vaginal bleeding does not always indicate a problem! Diagnosis Differential diagnosis Abortion Multiple pregnancy Polyhydramnios Treatment Suction dilation and curettage :to remove benign hydatidiform moles When the diagnosis of hydatidiform mole is established, the molar pregnancy should be evacuated. An oxytocic agent should be infused intravenously after the start of evacuation and continued for several hours to enhance uterine contractility Removal o