Gestational Trophoblastic Disease In Irrua Specialist Teaching Hospital, Nigeria: A 5-year Review

Abstract

Background: Gestational Trophoblastic Diseases (GTD) is a group of interrelated heterogeneous disease of trophoblastic tissue resulting from abnormal  fertilization, characterized by abnormal tissue proliferation. Characteristically, prognosis positively correlates with early diagnosis and treatment. Objective: The objective was to determine the burden, clinical presentation, management and outcomesof GTD at Irrua Specialist Teaching Hospital,  Irrua, Edo State, Nigeria. Methodology: A five-year descriptive (retrospective) study of histologically confirmed cases of st th GTD managed in ISTH between 1 July, 2016 and 30  June, 2021 was undertaken. Inclusion criteria: patient that were management at the study site, histology confirmation and availability of the case-file for  review. Women managed for other gynaecological disorders or those with suspected GTD but no histologic confirmation were excluded from the study.  Statistical analysis was done using SPSS version 20.0 and the results were presented in tables. Results: There were 21 cases of GTD and 4703 deliveries with an incidence of 4.5 per 1000 deliveries. The mean age of participants was 32.9±7.5 years. Partial mole was the commonest histologic type (47.4%), choriocarcinoma (31.6%), complete mole (10.5%), invasive mole and placenta site trophoblastic  tumor-PSTT (5.3%) respectively. Abnormal vaginal bleeding was the commonest presenting symptom 89.5% (17/19); others were excessive vomiting  52.6% (10/19) and abdominal pain 36.8% (7/19 ). The treatment modalities included suction curettage (42.1%) , suction curettage and chemotherapy  (36.8%), total abdominal hysterectomy and cytotoxic chemotherapy only (15.8%).Serum Beta hCG returned to normal within 4 weeks for molar pregnancy  and an average of 6 months for choriocarinoma. Default rate from surveillance was 10/19 (52.6%) while two participants (10.5%) died as cases  of choriocarcinoma with advanced disease from late presentation. Conclusion: Abnormal vaginal bleeding was the commonest presentation of GTD with high default and mortality rates. Therefore, efforts should be  geared towards education and awareness to improve early presentation, surveillance and prompt treatment.