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Vaginal Bleeding and Gestational Trophoblastic Disease

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Abstract

Molar pregnancy and gestational trophoblastic neoplasia (GTN) comprise a group of interrelated diseases, including complete and partial molar pregnancy, placental-site trophoblastic tumor (PSTT), and choriocarcinoma, that have varying propensities for local invasion and distal spread. Vaginal bleeding is a common presenting sign, seen in as many as 97% of women with a complete molar pregnancy; it is also a frequent symptom of all types of GTN [1].

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References

  1. Berkowitz RS, Goldstein DP, Bernstein MR. Evolving concepts of molar pregnancy. J Reprod Med. 1991;36(1):40–4.

    PubMed  CAS  Google Scholar 

  2. Yamashita K, Wake N, Araki T, Ichinoe K, Makoto K. Human lymphocyte antigen expression in hydatidiform mole: androgenesis following fertilization by a haploid sperm. Am J Obstet Gynecol. 1979;135(5):597–600.

    PubMed  CAS  Google Scholar 

  3. Keep D, Zaragoza MV, Hassold T, Redline RW. Very early complete hydatidiform mole. Hum Pathol. 1996;27(7):708–13.

    Article  PubMed  CAS  Google Scholar 

  4. Szulman AE, Surti U. The syndromes of hydatidiform mole. II. Morphologic evolution of the complete and partial mole. Am J Obstet Gynecol. 1978;132(1):20–7.

    PubMed  CAS  Google Scholar 

  5. Berkowitz RS, Goldstein DP. Management of molar pregnancy and gestational trophoblastic tumors. In: Knapp RC, Berkowitz RS, editors. Gynecologic oncology. New York: McGraw Hill; 1993. p. 328.

    Google Scholar 

  6. Benson CB, Genest DR, Bernstein MR, Soto-Wright V, Goldstein DP, Berkowitz RS. Sonographic appearance of first trimester complete hydatidiform moles. Ultrasound Obstet Gynecol. 2000;16(2):188–91.

    Article  PubMed  CAS  Google Scholar 

  7. Romero R, Horgan JG, Kohorn EI, Kadar N, Taylor KJ, Hobbins JC. New criteria for the ­diagnosis of gestational trophoblastic disease. Obstet Gynecol. 1985;66(4):553–8.

    PubMed  CAS  Google Scholar 

  8. Genest DR, Laborde O, Berkowitz RS, Goldstein DP, Bernstein MR, Lage J. A clinicopathologic study of 153 cases of complete hydatidiform mole (1980–1990): histologic grade lacks prognostic significance. Obstet Gynecol. 1991;78(3 Pt 1):402–9.

    PubMed  CAS  Google Scholar 

  9. Menczer J, Modan M, Serr DM. Prospective follow-up of patients with hydatidiform mole. Obstet Gynecol. 1980;55(3):346–9.

    PubMed  CAS  Google Scholar 

  10. Thaker HM, Berlin A, Tycko B, et al. Immunohistochemistry for the imprinted gene product IPL/PHLDA2 for facilitating the differential diagnosis of complete hydatidiform mole. J Reprod Med. 2004;49(8):630–6.

    PubMed  CAS  Google Scholar 

  11. Curry SL, Hammond CB, Tyrey L, Creasman WT, Parker RT. Hydatidiform mole: diagnosis, management, and long-term followup of 347 patients. Obstet Gynecol. 1975;45(1):1–8.

    PubMed  CAS  Google Scholar 

  12. Kohorn EI. Theca lutein ovarian cyst may be pathognomonic for trophoblastic neoplasia. Obstet Gynecol. 1983;62(3 Suppl):80s–1s.

    PubMed  CAS  Google Scholar 

  13. Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol. 1995;86(5):775–9.

    Article  PubMed  CAS  Google Scholar 

  14. Berkowitz RS, Goldstein DP, Bernstein MR. Natural history of partial molar pregnancy. Obstet Gynecol. 1985;66(5):677–81.

    PubMed  CAS  Google Scholar 

  15. Fine C, Bundy AL, Berkowitz RS, Boswell SB, Berezin AF, Doubilet PM. Sonographic diagnosis of partial hydatidiform mole. Obstet Gynecol. 1989;73(3 Pt 1):414–8.

    PubMed  CAS  Google Scholar 

  16. Osathanondh R, Berkowitz RS, de Cholnoky C, Smith BS, Goldstein DP, Tyson JE. Hormonal measurements in patients with theca lutein cysts and gestational trophoblastic disease. J Reprod Med. 1986;31(3):179–83.

    PubMed  CAS  Google Scholar 

  17. Berkowitz RS, Goldstein DP. Chorionic tumors. N Engl J Med. 1996;335(23):1740–8.

    Article  PubMed  CAS  Google Scholar 

  18. Hancock BW, Tidy JA. Current management of molar pregnancy. J Reprod Med. 2002;47(5):347–54.

    PubMed  Google Scholar 

  19. Elias KM, Goldstein DP, Berkowitz RS. Complete hydatidiform mole in women older than age 50. J Reprod Med. 2010;55(5–6):208–12.

    PubMed  Google Scholar 

  20. Orr Jr JW, Austin JM, Hatch KD, Shingleton HM, Younger JB, Boots LR. Acute pulmonary edema associated with molar pregnancies: a high-risk factor for development of persistent trophoblastic disease. Am J Obstet Gynecol. 1980;136(3):412–5.

    PubMed  Google Scholar 

  21. Goldstein DP, Berkowitz RS. Prophylactic chemotherapy of complete molar pregnancy. Semin Oncol. 1995;22(2):157–60.

    PubMed  CAS  Google Scholar 

  22. Kim DS, Moon H, Kim KT, Moon YJ, Hwang YY. Effects of prophylactic chemotherapy for persistent trophoblastic disease in patients with complete hydatidiform mole. Obstet Gynecol. 1986;67(5):690–4.

    Article  PubMed  CAS  Google Scholar 

  23. Limpongsanurak S. Prophylactic actinomycin D for high-risk complete hydatidiform mole. J Reprod Med. 2001;46(2):110–6.

    PubMed  CAS  Google Scholar 

  24. van Trommel NE, Massuger LF, Verheijen RH, Sweep FC, Thomas CM. The curative effect of a second curettage in persistent trophoblastic disease: a retrospective cohort survey. Gynecol Oncol. 2005;99(1):6–13.

    Article  PubMed  Google Scholar 

  25. Pezeshki M, Hancock BW, Silcocks P, et al. The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease. Gynecol Oncol. 2004;95(3):423–9.

    Article  PubMed  CAS  Google Scholar 

  26. Goldstein DP, Garner EI, Feltmate CM, Berkowitz RS. The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease. Gynecol Oncol. 2004;95(3):421–2.

    Article  PubMed  Google Scholar 

  27. Wolfberg AJ, Growdon WB, Feltmate CM, et al. Low risk of relapse after achieving undetectable HCG levels in women with partial molar pregnancy. Obstet Gynecol. 2006;108(2):393–6.

    Article  PubMed  Google Scholar 

  28. Berkowitz RS, Goldstein DP. Clinical practice. Molar pregnancy. N Engl J Med. 2009;360(16):1639–45.

    Article  PubMed  CAS  Google Scholar 

  29. Kohorn EI. Persistent low-level “real” human chorionic gonadotropin: a clinical challenge and a therapeutic dilemma. Gynecol Oncol. 2002;85(2):315–20.

    Article  PubMed  Google Scholar 

  30. Stone M, Bagshawe KD. An analysis of the influences of maternal age, gestational age, contraceptive method, and the mode of primary treatment of patients with hydatidiform moles on the incidence of subsequent chemotherapy. Br J Obstet Gynaecol. 1979;86(10):782–92.

    Article  PubMed  CAS  Google Scholar 

  31. Curry SL, Schlaerth JB, Kohorn EI, et al. Hormonal contraception and trophoblastic sequelae after hydatidiform mole (a Gynecologic Oncology Group Study). Am J Obstet Gynecol. 1989;160(4):805–9. discussion 809–11.

    PubMed  CAS  Google Scholar 

  32. Berkowitz RS, Goldstein DP, Marean AR, Bernstein M. Oral contraceptives and postmolar trophoblastic disease. Obstet Gynecol. 1981;58(4):474–7.

    PubMed  CAS  Google Scholar 

  33. Costa HL, Doyle P. Influence of oral contraceptives in the development of post-molar trophoblastic neoplasia–a systematic review. Gynecol Oncol. 2006;100(3):579–85.

    Article  PubMed  CAS  Google Scholar 

  34. Gaffield ME, Kapp N, Curtis KM. Combined oral contraceptive and intrauterine device use among women with gestational trophoblastic disease. Contraception. 2009;80(4):363–71.

    Article  PubMed  CAS  Google Scholar 

  35. Garrett LA, Garner EI, Feltmate CM, Goldstein DP, Berkowitz RS. Subsequent pregnancy outcomes in patients with molar pregnancy and persistent gestational trophoblastic neoplasia. J Reprod Med. 2008;53(7):481–6.

    PubMed  Google Scholar 

  36. Clark RM, Nevadunsky NS, Ghosh S, Goldstein DP, Berkowitz RS. The evolving role of hysterectomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center. J Reprod Med. 2010;55(5–6):194–8.

    PubMed  Google Scholar 

  37. Alazzam M, Hancock BW, Tidy J. Role of hysterectomy in managing persistent gestational trophoblastic disease. J Reprod Med. 2008;53(7):519–24.

    PubMed  Google Scholar 

  38. Cagayan MS, Magallanes MS. The role of adjuvant surgery in the management of gestational trophoblastic neoplasia. J Reprod Med. 2008;53(7):513–8.

    PubMed  Google Scholar 

  39. Dobson LS, Gillespie AM, Coleman RE, Hancock BW. The presentation and management of post-partum choriocarcinoma. Br J Cancer. 1999;79(9–10):1531–3.

    Article  PubMed  CAS  Google Scholar 

  40. Berry E, Hagopian GS, Lurain JR. Vaginal metastases in gestational trophoblastic neoplasia. J Reprod Med. 2008;53(7):487–92.

    PubMed  Google Scholar 

  41. Cagayan MS. Vaginal metastases complicating gestational trophoblastic neoplasia. J Reprod Med. 2010;55(5–6):229–35.

    PubMed  Google Scholar 

  42. Yingna S, Yang X, Xiuyu Y, Hongzhao S. Clinical characteristics and treatment of gestational trophoblastic tumor with vaginal metastasis. Gynecol Oncol. 2002;84(3):416–9.

    Article  PubMed  Google Scholar 

  43. Cockshott WP, Hendrickse JP. Persistent arteriovenous fistulae following chemotherapy of malignant trophoblastic disease. Radiology. 1967;88(2):329–33.

    PubMed  CAS  Google Scholar 

  44. Newlands ES, Bagshawe KD, Begent RH, Rustin GJ, Holden L, Dent J. Developments in chemotherapy for medium- and high-risk patients with gestational trophoblastic tumours (1979–1984). Br J Obstet Gynaecol. 1986;93(1):63–9.

    Article  PubMed  CAS  Google Scholar 

  45. McIvor J, Cameron EW. Pregnancy after uterine artery embolization to control haemorrhage from gestational trophoblastic tumour. Br J Radiol. 1996;69(823):624–9.

    Article  PubMed  CAS  Google Scholar 

  46. Lim AK, Agarwal R, Seckl MJ, Newlands ES, Barrett NK, Mitchell AW. Embolization of bleeding residual uterine vascular malformations in patients with treated gestational trophoblastic tumors. Radiology. 2002;222(3):640–4.

    Article  PubMed  Google Scholar 

  47. Garner EI, Meyerovitz M, Goldstein DP, Berkowitz RS. Successful term pregnancy after selective arterial embolization of symptomatic arteriovenous malformation in the setting of gestational trophoblastic tumor. Gynecol Oncol. 2003;88(1):69–72.

    Article  PubMed  Google Scholar 

  48. Gillespie AM, Liyim D, Goepel JR, Coleman RE, Hancock BW. Placental site trophoblastic tumour: a rare but potentially curable cancer. Br J Cancer. 2000;82(6):1186–90.

    Article  PubMed  CAS  Google Scholar 

  49. Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet. 2010;376(9742):717–29.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Brigham and Women’s Hospital, New England Trophoblastic Disease Center, 75 Francis Street, Boston, MA, 02115, USA

    Ross S. Berkowitz

Authors
  1. Lisa M. Barroilhet
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  2. Donald Peter Goldstein
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  3. Ross S. Berkowitz
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Corresponding author

Correspondence to Ross S. Berkowitz .

Editor information

Editors and Affiliations

  1. , Department of Ob/Gyn, Ben-Gurion University of the Negev, P.O. Box 151, Be'er-Sheva, 84841, Israel

    Eyal Sheiner

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Barroilhet, L.M., Goldstein, D.P., Berkowitz, R.S. (2011). Vaginal Bleeding and Gestational Trophoblastic Disease. In: Sheiner, E. (eds) Bleeding During Pregnancy. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-9810-1_4

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  • DOI: https://doi.org/10.1007/978-1-4419-9810-1_4

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-9809-5

  • Online ISBN: 978-1-4419-9810-1

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