Gestational Trophoblastic Disease

Gestational trophoblastic disease (GTD) describes a group of tumors related to pregnancy. The rare tumors are directly related to pregnancy in that they appear when there is rapid and uncontrollable proliferation of trophoblasts or a non-viable fertilized egg. Though, there is a spectrum of GTD, this chapter focuses primarily on diagnosis and management of molar pregnancy (hydatidiform mole). The clinical aspects of molar pregnancy can often mirror expectant clinical signs and symptoms of a normal pregnancy. However, diagnosis can typically be made in the first trimester by abnormal vaginal bleeding, hyperemesis, gravidarum, and larger than expected uterine size. Of most significance, the level of beta human chorionic gonadotropin is often abnormally elevated compared to expected values for gestational age. Ultrasound can be used to augment diagnosis, wherein there is typically a larger than expected uterus and no signs of life. The emergency physician can manage any hemodynamic instability and should coordinate care with an obstetrician/gynecologist who will ultimately need to evacuate the GTD, arrange histologic analysis, and subsequently coordinate any necessary chemotherapy.