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
Journal Title
Journal ISSN
Volume Title
Publisher
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.
Description
Keywords
Gestational Trophoblastic Disease (GTD)