A PROSPECTIVE OBSERVATIONAL STUDY ON CLINICAL PROFILE AND OUTCOME OF GESTATIONAL TROPHOBLASTIC DISEASE IN A TERTIARY CARE CENTRE

Abstract

Aim and background: To study the demographics and clinical profile of women
diagnosed with gestational trophoblastic disease. Also aims to study the outcome of
gestational trophoblastic disease in a period of 1 year.
Methods: This prospective observational study was conducted in 76 women who
were diagnosed with gestational trophoblastic disease (GTD) in a tertiary care centre
in South Kerala. Detailed history, clinical findings, investigations like TSH level,
serum βhCG levels,USG findings were noted. These women were followed up for 1
year with βhCG values and is assessed on each follow up visit for findings consistent
with gestational trophoblastic neoplasia (GTN) and remission. Variables were
compared with type of hydatidiform mole: complete and partial mole and statistical
significance assessed. To show the differences between pre-evacuation and post
evacuation βhCG values, paired t test was used.
Results: 76 patients were included in the study population and followed up for 1
year.76.4% of the patients belonged to 21-29yrs age group with mean age
25.4±4.29years.48.7% were primigravidae and the mean gestational age of
presentation was 7±3weeks.61.8% presented with routine USG showing features of
hydatidiform mole and 32.9% with vaginal bleeding.56.6%patients in the study
group had a preevacuation βhCG >1lakh mIU/ml.76.3% patients were complete mole
and 23.7% were partial mole. On follow up,14.47% of patients developed GTN;3
were invasive mole and one woman developed recurrent mole. Others had remission
mostly within 8 weeks after evacuation. All patients with GTN treated with
chemotherapy.6 patients were lost to follow up.
Conclusion: Early diagnosis of GTD is effectively possible with routine
ultrasonography and the incidence of complications due to GTD is significantly
reduced. Timely diagnosis, appropriate treatment, adherence to follow up and
contraception ensures 100% cure. βhCG remains the reliable marker for diagnosis
and follow up. Follow up of patients and awareness among population remains a
challenging task.
Clinical significance: This study builds a platform to know the demography of
GTD, its clinical features, various forms, importance of antenatal USG, βhCG
monitoring, warning signs of GTN and to assess the compliance to follow up and
contraception among GTD patients. Patient can be counselled regarding the natural
history of this disease, its progression, need of follow up as well as contraception.
Population based study should be proposed rather than hospital-based study to reveal
the actual burden this disease in our population.