ACOG Practice Bulletin 53: Diagnosis and Treatment of Gestational Trophoblastic Disease

Jul 18, 2026

Uploaded by Anda

ACOG Practice Bulletin No. 53 provides clinical management guidelines for gestational trophoblastic disease, a spectrum of placental disorders that includes complete and partial hydatidiform moles, invasive moles, gestational choriocarcinomas, and placental site trophoblastic tumors. The bulletin summarizes current evidence for diagnosis, staging, and management, emphasizing how sensitive quantitative β-hCG assays and modern chemotherapy enable cure for most malignant cases while preserving reproductive function. It also details incidence estimates, typical presentation patterns, and the need for referral when initial therapy fails or when choriocarcinoma is diagnosed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Diagnosis and Treatment of Gestational Trophoblastic Disease

Background and Incidence

Hydatidiform Mole

Classification

Diagnosis

ACOG PRACTICE BULLETIN CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN–GYNECOLOGISTS NUMBER 53, JUNE 2004 | | | --- | | This Practice Bulletin was developed by the ACOG Committee on Practice Bulletins—Gynecology and the SGO Education Committee with the assistance of John Soper, MD, Julian Schink, MD, and David Mutch, MD. The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice maybe warranted based on the needs of the individual patient, resources, and limitations unique to the institution or typeof practice.

| Diagnosis and Treatment of Gestational Trophoblastic Disease Gestational trophoblastic disease comprises a spectrum of interrelated conditions originating from the placenta. Other terms often used to refer to these conditions include gestational trophoblastic neoplasia and gestational trophoblastic tumor. Histologically distinct disease entities encompassed by this general terminology include complete and partial hydatidiform moles, invasive moles, gestational choriocarcinomas, and placental site trophoblastic tumors. Before the advent of sensitive assays for human chorionic gonadotropin (hCG) and efficacious chemotherapy, the morbidity and mortality from gestational trophoblastic disease were substantial. At present, with sensitive quantitative assays for β-hCG and current approaches to chemotherapy, most women with malignant gestational trophoblastic disease can be cured and their reproductive function preserved. The purpose of this document is to address current evidence regarding the diagnosis, staging, and management of gestational trophoblastic disease. Background Estimates for the incidence of various forms of gestational trophoblastic disease vary. In the United States, hydatidiform moles are observed in approximately 1 in 600 therapeutic abortions and 1 in 1,500 pregnancies (1) . Approximately 20% of patients will develop malignant sequelae requiring administration of chemotherapy after evacuation of hydatidiform moles (2, 3). Most patients with postmolar gestational trophoblastic disease will have nonmetastatic molar proliferation or invasive moles, but gestational choriocarcinomas and metastatic disease can develop in this setting. Gestational choriocarcinoma occurs in approximately 1 in 20,000–40,000 pregnancies: approximately 50% after term VOL. 103, NO. 6, JUNE 2004 ACOG Practice Bulletin No. 53 Diagnosis and Treatment of 1365 Gestational Trophoblastic Disease pregnancies, 25% after molar pregnancies, and the remainder after other gestational events (4) . Although much rarer than hydatidiform moles or gestational choriocarcinomas, placental site trophoblastic tumors can develop after any type of pregnancy (5, 6) . To allow optimal management, practicing obstetrician–gynecologists should be able to diagnose and mana

FAQs

What conditions are included in gestational trophoblastic disease?

Gestational trophoblastic disease covers interrelated placental conditions, including complete and partial hydatidiform moles, invasive moles, gestational choriocarcinomas, and placental site trophoblastic tumors.

How have diagnostic and treatment advances changed outcomes?

Sensitive quantitative assays for β-hCG and current chemotherapy approaches allow most women with malignant gestational trophoblastic disease to be cured while preserving reproductive function.

What clinical features suggest hydatidiform mole in the first trimester?

Common signs include abnormal bleeding, uterine enlargement beyond expected gestational age, absent fetal heart tones, cystic ovarian enlargement, hyperemesis gravidarum, and an abnormally high hCG level for gestational age.

Jul 18, 2026

Uploaded by Anda