Two main risk factors:

advanced maternal age

previous history of molar pregnancy

Other risks:

folate deficiency

most common in Taiwan and Philippines

The most common site of distant metastasis is the lungs.

• GTN occurring after a term pregnancy is almost always either choriocarcinoma or placental site trophoblastic tumor
• most common presentation is irregular vaginal bleeding lasting greater than the expected postpartum time (4-6 wks is considered normal) with nausea, vomiting, abedominal fullness, and if metastatic disease is present, cough, chest pain etc.
• Enlarged uterus and bilateral ovarian cysts (theca lutein cysts)

Mx

quantitative beta HCG

U/S

Suction currettage

Nearly 20% of patients who have had a molar pregnancy develop persistent gestational trophoblastic disease and are at risk for malignant transformation. Therefore, follow-up with serial quantitative beta-hCG levels until there are 3 consecutive normal values to confirm resolution.

Hydatidiform Mole