Pattern of gestational trophoblastic disease in sixty five Sudanese women presented to th e major hospitals in Kh atoum State (April 199 6 - April 1997) .


Research type: Research Paper

Authors: Idris, Mohamed Elamin .

Abstract: The aim of this study was to learn more about the epidemiology, clinical presentation and incidence of GTD (mole and chorioncarcinoma) in Sudanese women in Khartoum State, the ultimate objective being early diagnosis, awareness of complications and decrease in mortality. This study is a prospective, case control study, it has been done during the period from April, 1996 to April 1997 in the major hospitals of Khartoum State. Sixty five patients of GTD presented to these hospitals during the above mentioned period 89.2 percent of these were molar pregnancies and 10.8 percent were chorioncareinoma. 17.2 percent of the cases of molar pregnancies were PHM, while the others were CHM. The incidence of GTD, mole and chorioncarcinoma was relatively high (2.9, 16, 0.32 per 1000 births respectively). Increased maternal and husband age (greater less 40), low socio-economic status ethnicity, high parity, past history of mole and family history are strong risk factors for GTD and are statistically significant. Also, young maternal age (greater than 20 years) increase the risk of HFM. Maternal blood group, history of twins, history of fetal wastage, past history of oral contraceptive pills usage are of no significance statistically. Concerning the antecedent pregnancies in patients of chorioncarcinoma 42.8 percent were molar pregnancies, 28.6 percent were abortions and 28.6 percent were term pregnancies, noting that the antecedent pregnancies were moles in 15.5 percent of cases. The commonest presentation of HFM is ammenorrhoea (in 80.7 percent of patients) of a duration of 11-14 weeks in the majority of patients (48.1 percent), recurrent vaginal bleeding (in 86.2 percent) with a duration of 2-4 weeks in 50 percent of these patients, anaemia (60.4 percent), excessive morning sickness (53.4 percent), weight loss (20.7 percent), PIH (19 percent), uterus larger-than-dates (57 percent), 'doughy' abdomen (31 percent) and ovarian cysts (10.3 percent). The commonest presentation of chorioncarcinoma was vaginal bleeding in all cases. It was of a duration of more than 6 weeks in 85.7 percent of cases, ammenorrhoea (in 42.9 percent of patients) of a duration of more than 24 weeks in 66.7 percent of these patients, anaemia (85.7 percent), weight loss (71.4 percent) and excessive vomiting (14.3 percent). GTD was complicated by sepsis in 7.5 percent of cases and intractable haemorrhage in 9.2 percent of cases. To reach a diagnosis of GTD, clinical sense was used in all cases of HFM and chorioncarcinoma, urinary-HCG was used in 85.7 percent of cases in choriocarcinoma and 81 percent of HFM. Chest x-ray in 71.4 percent cases of chorioncarcinoma and 3.4 percent of HFM, and histopathology in 28.6 percent of chorioncarcinoma cases and 15.5 percent of HFM. The above mentioned investigations may be diagnostic but diagnosic values vary in each case. As and immediate supportive management, 42.9 percent of chorioncarcinoma cases were transfused while 41.4 percent of HFM cases were transfused, broad-spectrum antibiotics were given to 28.6 percent of cases of chorioncarcinoma and to 52 percent of HFM cases. While, as an immediate active management, 2 cases of chorioncarcinoma (28.4 percent) and one case of HFM (1.7 percent) had a hysterectomy, 69.6 percent of cases of HFM had medical and surgical evacuation and nothing was done for 71.4 percent of chorioncarcinoma cases and one case of HFM (1.7 percent). To reduce complications and mortality of GTD, doctors should be aware of the commonest modes of presentation in Sudanese women so as to enable early diagnosis. Centres for GTD patients should be established to provide easily accessible diagnostic procedures and early treatment of the disease.