Gestational Trophoblastic Diseases in a Teaching Hospital in Northern, Nigeria

Abstract

Background: Gestational trophoblastic diseases (GTD) is a spectrum of pregnancy-related premalignant disorders of complete and partial hydatidiform mole, and the malignant disorders of invasive mole, choriocarcinoma, and the rare placental-site trophoblastic tumour. Objective: This study was carried out to determine the incidence of gestational trophoblastic disease, the clinical features and management outcome at the Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: This was a retrospective study of the demographic and clinical data as well as management outcome of all patients with gestational trophoblastic disease managed between January, 2008 and December, 2012 at the Aminu Kano Teaching Hospital. Kano,Nigeria Results: There were 103 cases of GTD and 22,680 deliveries; giving an incidence of GTD as 4.5 per 1000 deliveries. Among them, 69 (67.0%) cases were hydatidiform mole while Choriocarcinoma was diagnosed in 34 cases (33.0%). The antecedent pregnancy among the cases of choriocarcinoma were hydatidiform mole in 18 cases (52.9%), miscarriage in 10 cases (29.4%) and ectopic pregnancy in 1 case (3.0%) and full term pregnancy in 5(14.7%) patients. GTD was commoner at the extremes of reproductive age. Hydatidiform mole was high 37(53.6%) in those aged 24 years and below, while choriocarcinoma was high 13(38.2%) in 45 -49 years age group. The most common presenting symptom was vaginal bleeding occurring in all the cases, while anaemia was the most common complication. Suction evacuation and follow up (67.0%) was the mode of treatment in all cases of molar pregnancy. Only cases of choriocarcinoma 34 (33.0%) had chemotherapy, 11(32.4%) cases had single agent while 23 cases (67.6%) had multi-agent chemotherapy. There were seven maternal deaths in this study, given a case fatality of 6.8%. Conclusion: The incidence of GTD in this study was 4.5 per 1000 deliveries. Vaginal bleeding was the commonest presenting symptom. Early diagnosis and appropriate treatment of this disease has an excellent prognosis, while late presentation was associated with high maternal mortality as found in this study.

Gestational Trophoblastic Diseases: A Review of the Clinical Presentation and Management at the Alex Ekwueme Federal University Teaching Hospital Abakaliki

“…A large proportion of the patients (76.5%) were of high parity (≥5) and this conforms with a report from some authors where most patients were of high parity [7]. A history of Previous molar gestation has consistently been shown to influence the risk of GTD [2].…”

“…This finding shows that the condition is common in our environment. The incidence of GTD in this study is comparable to the incidence of 4.7 per 1000 deliveries reported in Nnewi [4] and 4.5 per 1000 deliveries in Kano [2]. However, it is much higher than incidences of 1 per 1000, 1.3 per 1000, and 2 per 1000 pregnancies reported in the United States, the United Kingdom and Japan respectively [2].…”

“…The incidence of GTD varies greatly throughout the world [1] [2] [3] [4]. The exact incidence in Nigeria is not known [4].…”

“…Gestational trophobastic tumours account for 5.3% of gynaecological tumours in a study done in Enugu [4]. In Kano, the incidence of GTD was 4.5 per 1000 deliveries [2].…”

“…Ultrasound is a non-invasive, safe, economical and relatively simple technique used in the diagnosis of GTD [2] [4]. The definitive diagnosis is made by histological examination of the products of conception [4].…”