Gestational trophoblastic disease: current management of hydatidiform mole

#### Summary points Gestational trophoblastic disease consists of a pregnancy related group of disorders that were often fatal in the past. Much has been learnt in the past 50 years, however, and most women can now be cured. The United Kingdom has a highly centralised system for registering, monitoring, and treating women with this disease that requires close collaboration with non-specialist units and general practitioners. We review the important features for detection and successful management of the most common form of this disease, hydatidiform mole. The evidence is based on published studies—mostly retrospective case series—and expert opinion. Hydatidiform mole affects 1-3 in every 1000 pregnancies. About 10% of hydatidiform moles transform into one of the malignant forms of gestational trophoblastic disease, known as gestational trophoblastic neoplasia (box 1). #### Box 1 Classification of gestational trophoblastic disease ##### Benign forms ##### Malignant forms Hydatidiform moles are abnormal conceptions with excessive placental, and little or no fetal, development. The two major types—complete and partial—have distinctive histological and genetic features (boxes 2 and 3).1 2 3 4 5 6 7 Hydatidiform moles affect women throughout the reproductive age range but are more common at the extremes of the range.8 Women under 16 have a six times higher risk of developing the disease than those aged 16-40, and women who conceive aged 50 or more have a one in …