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First-Trimester Ultrasound in Gestational Trophoblastic Disease

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First-Trimester Ultrasound

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Abstract

Ultrasound plays an important role in the diagnosis and management of patients with gestational trophoblastic disease (GTD), including molar pregnancy and gestational trophoblastic neoplasia (GTN). The initial diagnosis of complete hydatidiform mole (CHM) is generally made with a markedly elevated human chorionic gonadotropin (hCG) and an abnormal ultrasound, which exhibits the classic snowstorm or grapelike appearance of the hydropic villi. The initial diagnosis of partial hydatidiform mole (PHM) by ultrasound in early pregnancy is less reliable. Overall, ultrasound is 34–57% sensitive in diagnosing molar pregnancy in the first trimester. The use of transvaginal ultrasound and color Doppler enhances the ability to assess the presence and extent of intrauterine disease in patients with GTN. Ultrasound measurement of uterine artery pulsations is predictive of the need for chemotherapy and may provide an indication of chemosensitivity in the management of patients. Furthermore, ultrasound is useful for the long-term follow-up of patients with GTD who develop abnormal bleeding following treatment to identify persistent disease, a new pregnancy event, or arteriovenous malformations. Lastly, ultrasound is essential in evaluating subsequent pregnancies to exclude recurrent GTD.

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Acknowledgements

The authors would like to acknowledge the contributions of Drs. Katharine Esselen and Donald P. Goldstein as prior co-authors to this chapter in the first edition. We would also like to recognize the support of the Donald P. Goldstein, MD, Trophoblastic Tumor Registry Endowment and the Dyett Family Trophoblastic Disease Research and Registry Endowment for support of the scholarly activities of the New England Trophoblastic Disease Center.

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  1. New England Trophoblastic Disease Center, Donald P. Goldstein M.D. Trophoblastic Tumor Registry, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Dana Farber/Brigham and Women’s Cancer Center, Division of Gynecologic Oncology and the Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA

    Kevin M. Elias, Neil S. Horowitz & Ross S. Berkowitz

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  1. Kevin M. Elias
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Correspondence to Ross S. Berkowitz .

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  1. University of Chicago, Chicago, IL, USA

    Jacques S. Abramowicz

  2. University of Chicago, Chicago, IL, USA

    Ryan E. Longman

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Elias, K.M., Horowitz, N.S., Berkowitz, R.S. (2023). First-Trimester Ultrasound in Gestational Trophoblastic Disease. In: Abramowicz, J.S., Longman, R.E. (eds) First-Trimester Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-24133-8_24

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