••• Chapter 50^ Gestational Trophoblastic Disease^497
❍ Why is induction of labor with oxytocin or prostaglandins not recommended for the evacuation of molar
pregnancies?
Uterine contractions against an undilated cervix theoretically carry an increased risk of the dissemination of
trophoblast throughout the systemic circulation.
❍ What type of ovarian cyst can be clinically evident (≥5 cm) in 25% to 35% of women with hydatidiform
mole?
Theca lutein cysts similar to those induced by gonadotropin/hCG ovarian hyperstimulation. These are generally
detected pre-evacuation but can arise within the first week after evacuation and can take up to 8 weeks to
disappear.
❍ List four possible etiologies for postevacuation associated respiratory distress.
(1) Trophoblastic deportation.
(2) High-output congestive heart failure secondary to anemia or hyperthyroidism.
(3) Pre-eclampsia.
(4) Iatrogenic fluid overload.
❍ Describe four important steps in the management of respiratory distress associated with molar evacuation.
(1) Ventilatory support with either supplemental oxygen or mechanical ventilation.
(2) Central monitoring including Swan-Ganz catheter.
(3) Diuresis as indicated by etiology.
(4) Correction of anemia or hyperthyroid etiologies of high output CHF as indicated.
❍ What precaution should be taken prior to evacuation in patients diagnosed with hyperthyroidism as a result
of a diagnosis of complete mole?
Administration of a beta-adrenergic blocker such as propranolol helps to prevent thyroid storm at the time of
evacuation or in the postevacuation period.
❍ List three other entities confused with twin gestation complicated by hydatidiform mole.
Retroplacental hematoma, partial hydatidiform mole, and nonviable twin can have similar presentations.
❍ Of those patients diagnosed with postmolar GTD, what percentage represents patients with persistent or
invasive moles versus those patients with choriocarinomas?
About 70% to 90% of these patients will have persistent or invasive moles, while 10% to 30% will have
choriocarcinomas.