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‘’A profile of cases of Gestational Trophoblastic Neoplasia at a large tertiary centre in Dubai” Authors : Tasneem Husaini Rangwala MD , MRCOG, Faiza Mahgoub Badawi FRCOG. Department of Obstetrics and Gynaecology, Latifa (Al Wasl )Hospital, Dubai, UAE.

Objectives Methods Results

35 cases of GTD were seen in 2 years with 7000 deliveries / year, giving a prevalence of 1 / 400 live births. Age range: 17 – 49 yrs . Peak in 21 to 30 years age group. .Parity range- 0 to 10 . majority in the parity group 1 to 4. 60% -local Arab nationals while 40% - expatriates

Conclusions

References

OPTIONALLOGO HERE

OPTIONALLOGO HERE

Objectives were To study:

(1)the prevalence of different types of gestational trophoblastic neoplasia (GTN) in the local and non local population of women at Latifa (Alwasl) hospital , a tertiary level referral centre for northern Emirates. (2)the safety of cervical preparation before uterine evacuation.

(3)the role of repeat uterine evacuation in curing these cases.

(4) the percentage of cases ultimately requiring chemotherapy.

GTD is rare but important pregnancy related disorder GTD is rare but important pregnancy related disorder

with an incidence of 1 in 400 in Asia and Latin America.with an incidence of 1 in 400 in Asia and Latin America.

It is a spectrum varying from benign It is a spectrum varying from benign Hydatidiform

mole (complete, partial mole) to malignant to malignant

conditions.conditions. ( invasive mole, choriocarcinoma and

Placental Site Trophoblastic Tumour) . .

Majority of cases can be cured by simple surgical Majority of cases can be cured by simple surgical

intervention. intervention.

Those cases requiring chemotherapy are generally Those cases requiring chemotherapy are generally

cured with very low toxicity treatment. cured with very low toxicity treatment.

Unlike other Gyn. malignancies fertility can be Unlike other Gyn. malignancies fertility can be

preserved and normal pregnancy outcome anticipatedpreserved and normal pregnancy outcome anticipated

Retrospective data collected for 2 Retrospective data collected for 2

years (from Jan. 2007- Dec. 2008) for years (from Jan. 2007- Dec. 2008) for

women admitted with suspected women admitted with suspected

diagnosis of molar pregnancy at AWH.diagnosis of molar pregnancy at AWH.

The data from 35 files were reviewed to The data from 35 files were reviewed to

extract information. extract information.

Descriptive statistics used.Descriptive statistics used.

Cases were managed according to institutional

protocol based on RCOG (Royal college of

obstetricians and gynaecologists) guidelines

HC no: Age Parity Symptoms Signs Baseline USG findings Prev. preg Cx priming Suction Ev Oxytocin

  (Yrs.)   Bleeding/ LFD uterus/ β-HCG Mole/missed   Yes/No Yes/No Yes/No

      vesicles ov cysts            

                     

                     

                     

                     

                     

                     

 PAGE -1                    

Compli- β-HCG F/U 2nd Evac outcome F/U duration histopathology Blood grp

cation Reg/Irreg yes/No cured/ need CT (months)    

             

             

             

             

             

 PAGE -2            

Previous pregnancy

Baseline HCG levels,Blood group type and initial USS findings:Baseline β-HCG levels (IU/L)

No :of cases

<1000 2–adm. from outside for re-evacuation

1000- 10,000 4

10,000-100,000

13

> 100,000 15

Not done 1

Total 35

Blood group

No :of cases

O 20

A 4

B 10

AB 1

TOTAL 35

ULTRASOUND FINDINGS

No :of cases

Complete mole 24

Partial mole 5

Missed miscarriage

1

?invasive mole 1

?molar changes 3

Scan not done 1

RESULTS (contd...)

Numbers needing chemotherapy according to:

Outcome of management

Total no=35

Cured by suction curettage

alone=20(57%)

Needed 2nd

evacuation= 11(31.4%)

Needed chemo =7/11 (63.6%)

Cured = 4/11(36.3%)

Needed chemo after 1st

evacuation= 1

Defaulted =3(8.5%)

1.Ka Yu Tse, Karen K L Chan, Kar Fai Tam, Hextan YS Ngan. Gestational Trophoblastic disease. Obstetrics , Gynecology and Reproductive medicine 2009; 19 issue 4: 89- 912. Philip savage. Molar Pregnancy.The obstetrician and Gynecologist 2008;10: 3-8. 3. N J Sebire, R A Fisher, M Foskett et al. Risk of Recurrence of Hydatidiform mole and subsequent pregnancy outcome following complete or partial Hydatidiform molar pregnancy. BJOG 2003; 110: 22-64.Royal College of Obstetricians and gynaecologists. The management of Gestational Trophoblastic disease. RCOG Green Top Guideline NO. 38 May 2009.5. Pezeshki M, Hancock BW, Silcocks P, Everard J E et al.The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease. Gynecol oncol 2004; 95: 423- 9 6. Flam F, Lundstrom V, Petterson F .Medical induction prior to surgical evacuation of Hydatidiform mole. Is there a greater risk of persistent gestational trophoblastic disease? Eur J obstet gynecol reprod biol 1991; 42: 57- 60. 7. B W L Tham, Everard J E, J A Tidy et al. Gestational Trophoblastic disease in the Asian population of Northern England and North Wales. BJOG 2003; 110:555-5598. M stone, K D Bagshawe. An analysis of the influences of maternal age, gestational age, contraceptive method and the mode of primary treatment of patients with Hydatidiform mole on the incidence of subsequent chemotherapy. . BJOG 1979;86:782-7929. Narendra pisal, John Tidy, Barry Hancock. . Gestational Trophoblastic disease. Is intensive follow up essential in all women? BJOG 2004; 12: 1449- 145110. N J Sebire, M Foskett, D Short, P Savage et al. Shortened duration of human chorionic gonadotrophin surveillance following complete or partial Hydatidiform mole: evidence for revised protocol of a UK regional trophoblastic disease unit. . BJOG 2007; 114:760-762

35 cases of molar pregnancies were managed at AWH during 2 yr period from Jan. 2007 to Dec. 2008Incidence: 1/40097.5% of cases had baseline β-HCG levels and initial ultrasound scan .60% were cured by suction curettage alone,11% by second evacuation , 22.8% needed chemotherapy .Default rate : 8.5 %Complications were minor and seen in 11% cases.Follow up was regular in 85.7% casesDuration of follow up - <6 mths. in 37.1 % casesThere were 37% cases of complete mole and 48.5% cases of partial mole . No cases of invasive mole, choriocarcinoma or PSTT were seen in the study period.1/12 cases that received cervical priming went on to have chemotherapy.

1. There should be a regional / national registry for GTD where all these cases are registered and receive appropriate follow up.2. All cases should have a baseline β- HCG level and pelvic ultrasound before any intervention.3. Caution during uterine evacuation can avoid serious complications.4. Cervical preparation with prostaglandin should be done in selected cases and prolonged preparation should be avoided.5. Repeat evacuation in selected cases avoids need for chemotherapy.

6. All cases of persistent GTD should have FIGO risk scoring and receive chemotherapy in specialised centres.7. Follow up is ideal for one year but cases should be counselled for contraception and refrain from pregnancy for at least 6 months