Review Note

SS_OB 1.19 Describe the anaesthetic management of early pregnancy conditions such as molar pregnancy

• Gestational trophoblastic disease (GTD)

• Risk factors:
• Advanced maternal age
• Very young maternal age
• Previous molar pregnancy
• Nutrition
• Presentation:
• Pain, bleeding, delayed period, elevated bHCG, no fetal cardiac activity, early pregnancy HTN, hyperemesis gravidarum
• Obstetric management:
• Testing then evacuation
• Prompt treatment important as if delayed can develop malignant disease (Ca)
• Suction curettage most common approach with USS, then weekly bHCG’s until undetectable
• Chemotherapy indicated if histology suggests invasive mole or choriocarcinoma, bHCG rise 10% over 2 weeks or persistence of measurable bHCG 6 months post evacuation
• Pre-op
• Usual + assess for complications of molar pregnancy:
• HTN
• Anaemia
• Thyrotoxicosis
• Hyperemesis gravidarum
• Cardiopulmonary distress(A-line)
• Intra-op
• Can do GA or spinal
• Risk of substantial blood loss - may be easier to monitor under GA
• 2x large bore IVL’s
• Valid G&H and blood products available
• May need oxytocin intra-op for contractions and to reduce blood loss