ABSTRACT
Gestational trophoblastic disease is a general term used to describe a spectrum of disease, ranging from the premalignant complete, partial hydatidiform moles through to the malignant invasive moles, choriocarcinomas, and placental-site trophoblastic tumors/epithelioid trophoblastic tumors. The latter malignant conditions are also collectively known as gestational trophoblastic tumors or neoplasia. Management of trophoblastic disease in the first instance involves evacuation of the uterus. This should always be done using a suction curette, and preferably with the help of ultrasound guidance. In the presence of persistently elevated human chorionic gonadotrophin (hCG) levels or continuing problems with hemorrhage, further evacuation may be necessary. This should normally be discussed with a gestational trophoblastic disease center because of the high risk of perforation, hemorrhage, or infection. Thereafter, if the hCG levels remain elevated, chemotherapy should be instituted. The vast majority of patients will respond to these measures due to the inherent chemosensitivity of gestational trophoblastic disease. Chemotherapy produces high cure rates while maintaining fertility, allowing women to have further pregnancies.
