Outcome of gestational trophoblastic disease in a rural tertiary centre of Haryana, India

Abstract

Background: The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). The reported incidence of GTD in India is inconsistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Haryana.Methods: Records of patients of GTD admitted from January 2014 to June 2016 were analyzed and incidence per 1000 deliveries was calculated. The demographic profile, clinical presentation, management and complications were studied.Results: There were 38 patients of GTD with an incidence of 2.3 per 1000 deliveries. Out of 38 patients 33 (86.8%) were of molar pregnancy and 5 (13.16%) had GTN. Out of 33 molar patients 27 (81.8%) had complete mole and 6 (18.2%) had partial mole. All cases of GTN were low risk and received single agent methotrexate based chemotherapy. The mean age was 23.02±2.96 years and 47.4% were primigravida. The mean gestational age of presentation was 13.84 ± 3.24 weeks. There were no mortalities and no recurrences. Education in more than half i.e. 57.1% patients was below primary and 7 of the 19 patients with GTD, who could be followed telephonically, were found to have not followed the contraceptive advice and conceived within 6 months of the treatment of molar pregnancies, 5 had vaginal deliveries of live babies one of which was preterm and rest 2 had spontaneous abortions.Conclusions: In view of poor reporting from developing countries there is a need for a nodal centre exclusively for GTD in each state. Poor compliance and contraceptive practice due to uneducated population especially in rural India, warrants a need for prophylactic chemotherapy in high risk cases.

A Prospective Study on Clinicoepidemiological Profile of Molar Pregnancy in a Tertiary Care Hospital

“…In present study most of the women (66%) with molar pregnancies are presented in their second trimester with a mean gestational age of 12.8±2 weeks. It is comparable to the study by Lakra et al (6), who reported 13.8±3 weeks as the mean age of gestation. Increase in diagnostic services over the years, have led to early recognition of the disease.…”

“…81% had pallor but 13.8% required blood transfusion. Lakra et al reported that 76.3% patients had pallor and 57.9% received blood transfusion (6).There were no ICU admissions or mortality in our study.…”

“…In 31% cases, it was more than 100,000 mIU/ ml. Serum β hCG of 18.4% patients was more than 1,00,000 mIU/ml in a study by Lakra et al (6).Jethwani et al reported 40% cases with β hCG more than 1,00,000 mIU/ml(9). In the present study, suction and evacuation was primary management method in 98% of cases of hydatidiform mole.…”

“…Agrawal reported 20.6 % of cases with theca lutein cysts (4). Lakra et al reported incidence of theca lutein cysts in 28.9% cases (6).…”

“…Invasive mole was found in only 1 case. In 3 patients (5.2%), the pre-evacuation serum β-hCG was less than 1,000 mIU/ ml, in 20 patients (34.5%) it was within 1,000 to 10,000 mIU/ ml, in 17 patients (29.3%) it was within 10,000 to 100,000 mIU/ ml, in rest 18 patients (31%) it was more than 100,000 mIU/ml ( (6). Dinesh Kumar et al from Imphal reported incidence of 4.5 per 1000 deliveries (7).…”