Cross sectional study : a five year review of gestational trophoblastic disease in Kuantan General Hospital (Jan 1995 - Dec 1999)

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Date
2001
Authors
Mohamed Jamli, Mohamad Faiz
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Universiti Sains Malaysia
Abstract
OBJECTIVES: To study the epidemiology, features, treatment of Gestational Trophoblastic Disease (GTD) and regression of serum BhCG in Hydatidiform mole. To identify factors that predict the risk of developing Gestational Trophoblastic Tumour (GTT) from Hydatidiform mole and to compare the outcome of treatment between Gestational Trophoblastic Tumour (GTT) from known antecedent pregnancy (Hydatidiform mole) and unknown antecedent pregnancy. METHODOLOGY: A Cross Sectional study of 96 cases of Gestational Trophoblastic Disease in General Hospital ofTengku Ampuan Afzan Kuantan for a period of 5 years (January 1995-December 1999). RESULTS: The prevalence rate of GTD in this hospital was 1 : 410 deliveries. There were 96 cases of GTD out of 39,011 deliveries. The prevalence rate was higher in the minority ethnic groups, women of lower socio-economic status, age ~ 41 years and parity more than 5. The commonest presentations was irregular vaginal bleeding (87%). Typical snow storm appearance was seen in 74.4% of the patients. In patient with hydatidiform mole , 64% has uterus larger than date. In patient with available serial serum B-hCG (n= 71), 79% (n=56) regressed spontaneously within 14 weeks and 21% (n=l5) had abnormal regression and were diagnosed to have Gestational Trophoblastic Tumour (GTT) . The significant risk predictors for development of GTT were age above 40 years , parity 5 and above, uterus larger than date , initial preevacuation B-hCG more than 100,000 miulml and pre-eclampsia . Type of hydatidiform mole, presence and size of theca lutein cyst and blood group were not significant predictor ofGTT. Eighty five patients were treated with suction curettage only and 8 patients (including 7 patients that had evacuation initially) had hysterectomy. 65.2% ofGTT received low risk, 17.4% received moderate and 17.4% received high risk regime of chemotherapy. There was no significant correlation between GTT from known and unknown antecedent pregnancy in relation to hysterectomy, type of chemotherapy, response of chemotherapy and mortality. CONCLUSIONS : GTD occurred in about 1: 410 deliveries and risk factors for development ofGTT had been identified. Close monitoring of GTD was mandatory so that appropriate management could be given. The prognosis for cure of these patients even when they developed GTT was good.
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Gestational Trophoblastic Disease (GTD)
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