Evaluation of clinical profile, management and outcomes of molar pregnancy

Abstract

Introduction: Hydatidiform mole is benign form of gestational trophoblastic disease characterized by hydropic swelling of the chorionic villi and proliferation of the trophoblasts. The majority of Hydatidiform mole is cured by simple surgical intervention. The disease can re-occur. The patients are followed up with serial serum BhCG till the normal level is achieved. With raised, plaetue level of serum β-hCG values, persistant GTD is diagnosed. So the proper monitoring and follow up of gestational trophoblastic disease is a must. It reduces both the morbidity and mortality of the women. This study details the clinical profiles and outcome of molar pregnancy.

Methods: This is an observational study conducted in Department of Obstretrics and Gynaecology at Tribhuvan University Teaching Hospital from 1st May 2015 to 30th April 2017 (2 years). Patients with the provisional diagnosis of molar pregnancy during the study period were included. After all required investigations, cases were managed according to the diagnosis. And were followed up with serial serum B-hCG. Further required treatment was given according the histopathological diagnosis.

Results: Total 46 cases of gestational trophoblastic disease (GTD) were diagnosed and it accounted for 4.9 per 1000 deliveries. Majority of patients belonged to age group of 20-40 years, presented during second trimester with amenorrhoea and per vaginal bleeding. Among these patients 93% (n=43) had suction evacuation, 5 % (n=2) had total abdominal hystrectomy with bilateral salphingo oophorectomy (TAH BSO), 2 % (n=1) had suction evacuation and laparotomy with untwisting of twisted theca luteal cyst. Thirteen patients developed persistent gestational trohphoblastic tumour (PGTT) and six patients were diagnosed as gestational trophoblastic neoplasia (GTN) and managed with multiagent chemotherapy.

Conclusions: Any deviation from normal norms in pregnancy or post delivery, gestational trophoblastic disease has to be thought of. Along with proper diagnosis and management, counseling regarding follow up should also be emphasized, which not only reduces morbidity but also reduces the mortality.