Incidence and risk factors of post-molar gestational trophoblastic neoplasia: a prospective study

Shana Rahman K. P.; Sudhamani C.

doi:10.18203/2320-1770.ijrcog20230788

Authors

Shana Rahman K. P. Department of Obstetrics and Gynecology, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, Kerala, India
Sudhamani C. Department of Obstetrics and Gynecology, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20230788

Keywords:

Beta-hCG, Gestational trophoblastic disease, Gestational trophoblastic neoplasia, IMCH, Vesicular mole

Abstract

Background: Gestational trophoblastic disease (GTD) is a group of disorders arising from abnormal trophoblastic cells. Gestational trophoblastic neoplasia (GTN) is a malignant counterpart of GTD. In the earlier era, morbidity and mortality associated with GTD was very high, 90-95% presenting with metastatic GTN in 1980’s.

Methods: This is a prospective study to analyze the incidence and to identify the risk factors of post-molar GTN and to evaluate the role of Beta-hCG level as a predictive factor of post-molar GTN, conducted in the department of Obstetrics and Gynecology, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, on patients attending the vesicular mole(VM) clinic. Group A (remission group - was diagnosed after 6 months of follow-up with undetectable Beta-hCG values) and Group B (post-molar GTN). The two groups were compared for identifying risk factors.

Results: There were 79 cases of molar pregnancy registered in VM clinic with an incidence of 4.87/1000 deliveries. Of the 79 patients with GTD, 17 were diagnosed to have GTN during follow-up with an incidence of 21.51% of GTD. Incidence of post-molar GTN were significantly more among patients with history of previous molar pregnancy. The median Beta-hCG level at 2 weeks post-evacuation and the ratio of Beta-hCG levels at 1week to 2 weeks post-evacuation was found to be highly predictive of post-molar GTN.

Conclusions: Incidence of GTD was higher compared to international studies. The ratio of post-evacuation Beta-hCG at 1 week to Beta-hCG at 2 weeks is the most reliable predictor of post-molar GTN.

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