Gestational trophoblastic disease in 2005

Abstract

Gestational trophoblastic diseases are still problematic in our practice. Event the incidence is in generally decreasing. And the development of Medicine in this decade can elucidate some parts of pathophysiology at cellular and molecular levels. However, malignant changes still can not be prevented. Approximately 20% of patients will develop malignant sequelae requiring administration of chemotherapy after evacuation of hydatidiform moles. Most patients with postmolar gestational trophoblastic disease will have non-metastatic molar proliferation or invasive moles, but gestational choriocarcinomas and metastatic disease can develop in this setting. Gestational choriocarcinoma occurs approximately 50% after term pregnancies, 25% after molar pregnancies, and the remainder after other gestational events. Although much rarer than hydatidiform moles or gestational choriocarcinomas, placental site trophoblastic tumors can develop after any type of pregnancy. For optimal management, practicing obstetrician-gynecologists should be able to diagnose and manage primary molar pregnancies, diagnose and stage malignant gestational trophoblastic neoplasia, and assess risk in women with malignant gestational trophoblastic neoplasia. This chapter views some points which may be useful for evidence-based practice in modern Medicine.