Gestational trophoblastic disease
Gestational trophoblastic disease (GTD) is a group of conditions when a pregnancy does not develop in the normal way. The most common type of GTD is a molar pregnancy, when either no baby is present (called a complete mole) or there are early signs of a baby developing but the baby is abnormal and could never survive (a partial mole). A complete mole is caused when a sperm (or more than one sperm) fertilizes an egg which is abnormal and contains no genetic material. A partial mole occurs when two sperm fertilize a normal egg. GTD is more common if you are a teenager, aged over 40 years or are of Asian origin.
Symptoms of GTD include: irregular or heavy vaginal bleeding; severe morning sickness (called hyperemesis); abdominal pain; or new symptoms of an overactive thyroid. A health professional may suspect GTD if: your womb feels larger than expected for the stage of pregnancy you are at or you suddenly develop high blood pressure early in pregnancy. If GTD is suspected you will be referred for an ultrasound scan. A health professional will also do a blood test to check the level of the pregnancy hormone human chorionic gonadotrophin (hCG) as this is usually very high with GTD. Sometimes GTD is found when you are having an ultrasound for another reason or when pregnancy tissue is examined in a pathology lab following a miscarriage.
Usually surgical management will be recommended for GTD. The procedure is the same as surgical management of miscarriage (see above for more information). Occasionally other treatment will be recommended, for example if you are pregnant with twins and there is one healthy baby, but this is rare and your health professional will give you more information about this.
Rarely GTD can develop into cancers, called gestational trophoblastic neoplasia (GTN). This happens if some of the GTD pregnancy tissue (even just a few cells) remains in your uterus following treatment. These cancers include: invasive mole, choriocarcinoma, placental site trophoblastic tumpur and epithelioid trophoblastic tumour. Very rarely GTN can occur after a miscarriage or a healthy pregnancy.
To make sure that GTD has been treated, you will be followed-up after treatment. Because GTD is rare, follow-up is guided by three specialist centres (London, Sheffield or Dundee). You will be asked by your health professional if they can pass on your details to the nearest specialist centre. Follow-up involves monitoring the level of hCG in your urine (the specialist centre will send you instructions) and blood (you will need to go to your referring hospital or GP for blood tests). The length of follow-up varies depending on how quickly the level of hCG drops. The cure rate is 98-100%. If you have GTN you may need chemotherapy drugs. This happens to 15% of women (1 in 7) with a complete mole and 0.5% women (1 in 200) who have a partial mole. Some women also need further surgery.
All information on this website, and advice and support offered by the charity team is on a non-medical basis. The charity advises that anyone going through baby loss, medical treatment or health issues, should seek advice from their own GP, Consultant, Midwife or Healthcare Professional.Download the Saying Goodbye Support Leaflet (PDF)