Gestational Trophobastic Diseases

By Dr. Asma Khan | Dr. Gowri Sai Prasad | Dr. Ajit Patil

Transcript

1. GESTATIONAL TROPHOBASTIC DISEASES
2. CASE A 25 year old female P-1, L-1, A-1, Non- Tubectomised came through casualty with c/o- • Pain Abdomen since 4days. • Excessive P/V bleeding since morning.
3. HISTORY OF PRESENT ILLNESS Patient was apparently well 4days back when she started having pain abdomen, continuous in nature, severe in intensity, radiating to back and thighs. No aggravating and relieving factors. Started having excessive P/V bleeding (No Clots) since morning soaking 4pads, associated with pain abdomen.
4. • No H/O nausea, vomiting, fever. • No H/O weakness, lethargy, dizziness, weight loss. • No H/O palpitation, excessive sweating, tremors , cough, dyspnoea, orthopnea, PND or hemoptysis, chest pain. • No H/O epigastric pain, blurring vision, diplopia, headache, convulsions. • No H/O Bladder/Bowel complaints.
5. Menstrual History • Menarche: 14yrs. • PMC: 4 to 5/28days. Regular, 3pads/day. not associated with clots/dysmenorrhoea. • LMP: 25/12/13. • LLMP: 24/11/13.
6. OBSTETRIC HISTORY • Married life- 7years. (Non-consanguineous marriage). • P-1, L-1: Male 6yrs, FTNVD. (Anti-D taken). • A1: Spontaneous Abortion (2years back) / 2months/DandC done. (Anti-D taken). • No H/O any Contraception.
7. PAST HISTORY • No H/O HTN, DM, Asthma, TB, Epilepsy. • No significant Surgical/Medical history. • No History of Blood transfusion. FAMILY HISTORY • No H/O similar complaints. PERSONAL HISTORY • Mixed diet. • Sleep and appetite normal. • Bladder/Bowel normal and regular.
8. EXAMINATION Patient stable. GC fair. Pallor +++ Afebrile. Pulse: 108/min. BP:120/70mmHg. R/S: B/L equal air entry. No added Sounds. CVS: S1.S2 heard. Haemic Murmur +
9. Per Abdomen: Mass ≈ 24weeks size. Firm, non-mobile, tender. Lower pole couldn’t be reached. Per speculum: cervix and vagina – healthy Per vaginally :firm,non-mobile mass felt not felt separate from uterus.
10. INVESTIGATIONS Blood Grp: A –ve. HIV,HBsAg: -ve. HB: 4gm/dl. TLC: 5,500/cumm. UPT: Positive. Platelet: 1.59Lac/cumm. RBS: 85.8mg/dl. S.Urea: 31mg/dl. S.Creatinine: 0.9mg/dl. Bilirubin- Total= 0.6mg/dl, Direct= 0.2mg/dl. SGOT= 40.4 I.U/L, SGPT= 21.1 I.U/L ALP= 98 I.U/L Total Protein= 6.3g/dl. Albumin= 2.9g/dl. B.T= 02:30. CT= 05:10. PT: Test=14secs. Control=14secs. INR=1. B-HCG: >10lacs. TSH: 0.059 micro.I.U/ml Urine R/M: NAD.
11. ECG and CXR: Normal. USG: degeneration of submucous fibroid seen. MRI (Abdo-Pelvis): Invasive Mole with superficial myometrial invasion. No Lymphadenopathy, No Distant Metastasis.
12. • 3Units PCV transfused for correction of anemia. • Patient was planned for exploratory laprotomy + total abdominal hysterectomy i/v/o MRI showing invasive mole. • Intra-OP: Uterus nearly 24weeks size. Surface of uterus Intact. No Serosal breech. B/L Ovaries normal. • On dissection, few vesicles and blood clots seen adherent to posterior uterine wall.
15. TOTAL ABDOMINAL HYSERECTOMY
19. POST-OP Management: Inj.Augmentin I.V 12hrly for 7days. Inj.Metrogyl 100ml I.V 8hrly for 5days. Inj.Pantop 40mg I.V O.D for 5days. Inj.Inac 1amp. I.M 12hrly. • Post-Op CBC Hb=7.2, TLC= 6,300. Platelet= 1.26Lac. – 2Units PCV Transfused. – Anti-D given 300micrograms. I.M stat. (POD 2) – Repeat B-HCG= 74,000 mIU/ml
20. HISTO-PATHOLOGY: Suggestive of Chorio-Carcinoma. Treatment: • EMACO regimen. • Patient doing well after 2cycles of chemotherapy.
21. DR ASMA KHAN[ RESIDENT] DR GOWRI SAI PRASAD[ASSOCIATE PROFFESOR] DR AJIT PATIL [HOD] THANK YOU