Gestational Trophoblastic Disease ECHO-Case Presentations from Fiji Training Site

Video Transcription

Video Summary

The transcript is a case-based discussion on gestational trophoblastic disease (GTD) in Fiji and the Pacific, led by gynecologists Andy Garrett and Nani. It highlights major challenges in low-resource and geographically dispersed settings, especially delayed beta-hCG testing, missed follow-up, and fragmented care across hospitals and countries.

<strong>Case 1</strong> involved a 35-year-old woman with early pregnancy bleeding, very high beta-hCG, and no visible intrauterine pregnancy. She was initially monitored as a pregnancy of unknown location but was lost to follow-up because she lived far from the tertiary center. Months later she returned critically ill with respiratory symptoms, extremely elevated beta-hCG, and widespread lung metastases. She underwent hysterectomy, and pathology confirmed <strong>choriocarcinoma</strong>. Although multi-agent chemotherapy was planned, she deteriorated before treatment could begin and died. The case emphasized the importance of earlier imaging, faster diagnosis, and robust follow-up systems.

<strong>Case 2</strong> involved a 40-year-old doctor who presented with a complete molar pregnancy. After suction curettage, she traveled for work, had repeat uterine procedures and hysterectomy overseas, and later was found to have persistent GTD with pulmonary nodules. She received multi-agent chemotherapy and achieved beta-hCG remission.

The discussion focused on:
- when to repeat imaging or perform curettage,
- when hysterectomy is appropriate,
- how to manage high-risk metastatic disease,
- the role of <strong>low-dose EP induction chemotherapy</strong> in critically ill patients,
- and the need for a <strong>national GTD registry</strong> with recall systems and standardized surveillance.

Overall, the session stressed that GTD is highly treatable if follow-up and treatment are timely.

Keywords

gestational trophoblastic disease

choriocarcinoma

molar pregnancy

beta-hCG

pulmonary metastases

follow-up systems

low-resource settings

hysterectomy

chemotherapy

national GTD registry

surveillance