GESTATIONAL TROPHOBLASTIC DISEASE IN BASRAH

To date few studies have been reported from Basrah regarding Gestational Trophoblastic disease GTD. This study was a clinical observational study done in Basrah at the 4 main obstetric hospitals based on 137 patients with GTD. The objective was to study the incidence of Hydatidiform Mole gestation and other Gestational trophoblastic diseases in Basrah and to review the clinical presentation and management of Hydatidiform Mole gestation in Basrah. Clinical records of patients were reviewed with regards to presentation, investigation, management and outcome. Of 137 patients, there were 132 patients (96%) treated for hydatidiform mole, 3 patients (2%) were treated for choriocarcinoma, 1(1%) patient had invasive mole and 1(1%) patient had placental site tumor. The incidence of molar pregnancy and choriocarcinoma was 1.7/1000 deliveries and 0.04/1000 deliveries, respectively. Molar pregnancy seems to be a common problem in Basrah but sever complications such as pre-clampsia & thyrotoxicosis were not reported in this study. INTRODUCTION Gestational trophoblastic diseases (GTD) represent a spectrum of neoplastic disorders that arise from placental trophoblastic tissue after abnormal fertilization. Gestational trophoblastic diseases are classified histologically into four distinct groups: hydatidiform mole (complete and partial), chorioadenoma destruens (invasive mole), choriocarcinoma, and placental site tumor. These tumors are rare and constitute less than 1% of all gynecological malignancies. The reported incidence of GTD varies in different regions of the world. Overall, approximately 80% of cases of GTD, are hydatidiform moles, 15% are chorioadenoma destruens or invasive mole, and 5% are choriocarcinomas. Choriocarcinoma is associated with an antecedent mole in 50% of cases, a history of abortion in 25%, term delivery in 20%, and ectopic pregnancy in 5%. True estimates of the incidence of molar pregnancies are difficult to obtain because of considerable worldwide variation in the presentation and management of both normal and abnormal pregnancies. The incidence of molar pregnancy demonstrated marked geographic and ethnic differences, ranging from the highest incidence of 1 in 120-400 pregnancies in Asian countries such as Taiwan, Philippines and Japan, to the lowest incidence of 1 in 1000 to 2000 in Europe and the USA. In Iraq the incidence is 1 in 221according to previous statistics. To date few studies have been reported from Basrah regarding Gestational Trophoblastic disease therefore this study was conducted to study the incidence of Hydatidiform Mole gestation and other Gestational trophoblastic diseases in Basrah and to review the clinical presentation and management of Hydatidiform Mole gestation in Basrah. PATIENTS AND METHODS This is a retrospective study done in Basrah at the 4 main obstetric hospitals Basra maternity and child hospital, Al Basrah general hospital, AL Faihaa hospital and Al Tahrer hospital through the period of one year (the first of May 2005 till first of May 2006). A special questionnaire form was designed to collect information about those patients who are included in the study, this included points about the history, examination, investigations & management related information about the progress of the patients collected from the clinical records in these hospitals and histopathological laboratories records. Patient who needed chemotherapy were treated in the Oncology center in Basrah Teaching hospital. The management of patients in all 4 hospitals included history, clinical examination which was performed to assess patient's general condition, size of the uterus & presence of adnexal masses. Full laboratory evaluation obtained as a part of pretreatment follow-up, full blood count; urea and electrolytes, thyroid function test, and serum βHCG level were obtained. Radiological investigations included chest X-ray and pelvic ultrasound were done to all patients. CT scan of the brain and pelvis was done in patients in which metastasis was MJBU, VOL 25, No.2, 2007 53 suspected. The diagnosis of malignant GTD was based on clinical, radiologic, and biochemical evidence of metastases. After assessment of the general condition by complete investigations and correction of anemia and dehydration, cases of molar pregnancy were treated by evacuation of the uterus by traditional curettage under general anesthesia using sponge forceps and curette since no suction curettage is available. In most of the patients a second evacuation was done routinely according to the ultrasound result in about 10 days later and each time a biopsy was obtained for histopathological examination. Other cases of GTD were treated accordingly. After confirmation of the diagnoses by histopathology, the patients were followed up by βHCG level; follow up was difficult because of the absence of a special referral center and lack of HCG assay in most of the hospitals but most of the cases were followed up by private laboratories. RESULTS There were 78674 deliveries during the study period and 137 cases of (GTD) were reported. There were 132 patients (96%) of them were treated for hydatidiform mole, 3 patients (2%) were treated for choriocarcinoma, 1(1%) patient had invasive mole and 1(1%) patient had placental site tumor. As shown in (Table-1). The incidence of molar pregnancy and choriocarcinoma was 1.7/1000 deliveries and 0.04/1000 deliveries, respectively. The majority of hydatidiform mole cases were complete molar pregnancy 119 (90%) and only 13(10%) were partial. As shown in (Table-1). Table 1.Cases of gestational trophoblastic diseases. Gestational trophoblastic diseases No. % Hydatidiform mole 132 Partial = 139 Complete = 13 96