Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No. 53

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.