Objectives Gestational Trophoblastic Neoplasia (GTN) cure rates reach >90% in settings where early diagnosis and management strategies exist. GTN is more common in African countries, where many factors effecting outcomes are not readily available. To address the high prevalence of invasive molar pregnancies in Rwanda we developed training in sonographic recognition, clinical diagnosis and management of GTN in the largest teaching hospital in Kigali, Rwanda.
Methods We evaluated our approach to GTN management in the largest tertiary care teaching hospital in Rwanda.
Results A patient registry of GTN patients was created with gynecologic oncology specialists. From October 2015 to June 2019 we identified 108 patients with GTN, 80 of which were diagnosed with invasive mole. Residents at all levels received training in ultrasound recognition of invasive versus noninvasive mole characteristics, GTN staging and scoring, methotrexate dosing and toxicity, B-hCG monitoring and identification of high risk or resistant disease. Residents were also trained in the appropriate use of hysterectomy in the management of Gestational Trophoblastic Disease.
Conclusions Recently trained OB/GYN residents practicing at hospitals countrywide are now able to identify and refer appropriate patients to the GTN center at the university teaching hospital in Kigali, Rwanda. Based on these results we feel that appropriate GTN diagnosis and management can be taught in a low resource setting, even outside of the university teaching hospital, to improve patient outcomes despite limited resources.
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