Incidence and clinical outcome of Gestational Trophoblastic diseases in a tertiary care hospital

Introduction: Gestational trophoblastic disease (GTD) consists of group of disorders having pathology of abnormal trophoblastic proliferation ranging from hydatidiform mole to gestational trophoblastic neoplasia. Based on differences in morphology, histopathology, karyotype and clinical features, hydatidiform mole can be categorized into partial and complete moles. Molar pregnancy incidence varies across countries. The incidence of molar pregnancy in Asia is 1:100-300, choriocarcinoma 1:1000-2000 of live born children. Aim: To determine the incidence, clinical outcome and management of women with gestational trophoblastic disease (GTD) at tertiary care hospital during a study period of 6 months. Materials and Methods: This is an observational descriptive study conducted over a period of 6 months. In our study, total 18 cases were diagnosed with GTD, based on ultrasound, biochemical and histological examination. Results: During study period, total patients delivered were 3610, out of which 18 cases had GTD. The overall incidence of GTD was 1/200 pregnancies, including cases of partial mole, complete mole, choriocarcinoma, and invasive mole. Highest incidence was found in extremes of age. 77.7% of cases presented in the first trimester, while 22.3% of cases presented in the second trimester. 77.7% of cases were complete mole, 11.1% were partial mole, and 11.1% were diagnosed as gestational trophoblastic neoplasm. Majority of cases (94.4%) presented with vaginal bleeding; pregnancy induced hypertension and preeclampsia was present in 16.6% of cases, 66.6% had abdominal cramps, 44.4% presented with signs of dehydration due to hyperemesis gravidarum, 22.2% had hyperthyroidism. Ultrasound was diagnostic in 95% cases, while histopathological examination was diagnostic in 100% of the cases. The incidence of GTDs in our hospital (1 in 200) is comparable to the incidence in Middle East and Far Eastern countries. Conclusion: In our study, we found a high incidence of GTD in primigravidas. Most patients who had been diagnosed with GTD on USG were in first trimester.