Introduction/Background A Clinical Audit of molar pregnancies and gestational trophoblastic neoplasia cases over 1yr was conducted at Kolkata Medical College & Hospital, a tertiary care hospital of Eastern India with respect to the incidence of disease, factors related to etiopathogenesis, diagnosis and management and effects on maternal morbidity and mortality.
Methodology A total of 10000 patients attended this institution during 2017 june to 2018 june for pregnancy or its complication in department of gynaecology & obstetrics.85 molar pregnancies and their sequelae were followed up in medical oncology. The data was collected from out patient & in patient tickets & admission registrars and was analysed by descriptive statistics.
Results Most cases were seen amongst the second gravida 40%, Hindus 53.3%, low socio-economic strata 72%.Predominant Blood group was B 53%. Hemoglobin below 10 mg/dl was seen in 94%. 21.33% of patients had haemoglobing was below 6 gm/dl.Most of the patients of Hydatiform Mole (50%) were diagnosed within a period of ammenorhea of 8–12 weeks with 70% of cases diagnosed with amenorrhoea of less than 16 weeks. 18% of patients were diagnosed after a period of amenorrhoea of greater than 20 weeks. The most common presenting symptom in cases of Hydatiform Mole was Bleeding per vagina 74%. Features of Hyperthyroidism & respiratory distress were seen in 5% of patients. The most common signs were pallor 65%, pre-eclampsia were seen in 17.33%% of patients.
Suction & Evacuation 58.66%% with Oxytocin infusion was the predominant mode of management in cases of Hydatiform Mole. Ligation was done in one patient considering the risk of repeat molar pregnancy in future conception.
Modes of diagnosis were clinical (74%), & USG in 68%.
Persistent Gestational Trophoblastic Disease and Choriocarcinoma were diagnosed during follow up by symptoms of irregular bleeding P/V, elevated beta HCG titre and abnormal USG pelvis and chest X-Ray.
Chemotherapy was the predominant mode of treatment of GTT. hysterectomy was done in 2 patients of Invasive mole.
Single agent chemotherapy with Methotrexate in 20 patients 83.33% i.e low risk GTT. EMA-Co regimen was the preferred multiagent chemotherapy used in 4 patients 18%(upfront) and in 2 patients progressing on methotrexate, surgery in 1patient not responding to EMACO or EMA-EP.
Toxicity of chemotherapy was predominantly, Nausea & vomiting (38.89%) mucousitis (27.78%).Hepatotoxicity and infection was seen in 11.11% of patients. Grade3/Grade4 toxcity was nil.
Conclusion Though the proportion of molar pregnancies & gestational trophoblastic neoplasia is not much in comparison to the heavy attendees in the gynaecology and obstetrics opd but they represent a highly curable one with minimally intense chemotherapy thus avoiding unnecessary hospital stay due to chemotoxicity.
Disclosure I do not have any conflict of interestwith any person or organization.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.