🔑 Key Learning

  • GTD includes molar pregnancy, choriocarcinoma, invasive mole, and placental site trophoblastic tumour.
  • Presents in early pregnancy with abnormal PV bleeding, hyperemesis, and markedly raised β-hCG.
  • Ultrasound shows a classic "snowstorm” or "bunch of grapes" appearance.
  • Managed with uterine evacuation and serial β-hCG monitoring to detect persistent disease.

🧬 Pathophysiology

  • Abnormal trophoblastic proliferation due to atypical fertilisation events.
  • The spectrum of GTD includes:
    • Complete mole
    • Partial mole
    • Choriocarcinoma
    • Placental site trophoblastic tumour 

👀 Clinical Features

  • Abnormal vaginal bleeding in 1st trimester (6–12 weeks) - spotting to heavy bleeding
  • Uterus larger than expected for gestational age
  • Severe hyperemesis gravidarum
  • Early-onset pre-eclampsia (rare, severe cases)
  • Symptoms of hyperthyroidism (due to β-hCG cross-reactivity with TSH receptor)

🧪 Investigations

  • Transvaginal ultrasound:
    • “Snowstorm” or “bunch of grapes” appearance
    • No identifiable foetus in complete mole
  • Serum β-hCG:
    • Markedly raised, much higher than expected for gestational age
  • Histology:
    • Hydropic villi, trophoblastic hyperplasia (diagnostic post-evacuation)
Figure 203: US molar pregnancy: A "snowstorm" or "bunch of grapes" appearance, due to multiple cystic structures.

     

💊 Management

  • Uterine evacuation by suction curettage under general anaesthetic
  • Serial serum β-hCG monitoring until normal for 6 consecutive months
  • Contraception advised during follow-up (avoid pregnancy while β-hCG is monitored)
  • Chemotherapy (e.g. methotrexate) if:
    • β-hCG plateau or rise
    • Histology confirms invasive mole or choriocarcinoma
  • Placental site trophoblastic tumour often requires surgical resection

📝 Exam Clues & Clinchers

  • 1st trimester bleeding + uterus large for dates + hyperemesis + very high β-hCG
  • Snowstorm appearance on ultrasound