A study of factors affecting regression of βhCG in gestational trophoblastic disorders
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20190864Keywords:
βhCG, Persistent trophoblastic disease, Risk factorsAbstract
Background: Gestational trophoblastic disorders are among the rare human tumors that can be cured even in the presence of widespread dissemination. Authors can anticipate the development of persistent trophoblastic disease by identifying high risk factors affecting βhCG regression in vesicular mole. The study of this aim was to determine the incidence of gestational trophoblastic disorders and persistent trophoblastic disease in our institution. Factors affecting regression of βhCG and thereby leading to persistent disease are assessed.
Methods: The study was conducted for a period of 2 years at a tertiary care centre in central Kerala. The factors affecting progression to persistent disease are assessed by a case control study. Those developing persistent trophoblastic disease were taken as cases and those with normal regression of βhCG were taken as controls. Variables studied were age, sociodemographic factors, obstetric history, histopathological report, βhCG value, post evacuation USG and clinical features.
Results: The incidence of gestational trophoblastic diseases was 1 in 178 births and of persistent trophoblastic disease was 18.6%. Fourteen cases with persistent trophoblastic disease were studied and 61 controls were recruited. Incidence increased in older age group (>30) and low socio-economic group. Pre-evacuation βhCG> 40000 and presence of theca lutein cyst are important factors affecting βhCG regression. Strong association with uterine size >poa, post evacuation uterine subinvolution and presence of hyperthyroidism was found.
Conclusions: Progression to persistent trophoblastic disease was associated with low socioeconomic status, high pre-evacuation βhCG values, uterine size>poa and presence of theca lutein cysts. Identification of these risk factors helps in proper counseling and meticulous follow up of patients.
References
Stevens FT, Katzorke N, Tempfer C, Kreimer U, Bizjak GI, Fleisch MC, et al. Gestational trophoblastic disorders: an update in 2015. Obstetr Gynecol.2015;75(10):1043-50.
Deep, Jagat, Sedhai LB, Napit J, Pariyar, Jitendra. Gestational trophoblastic disease. J Chitwan Med Coll. 2013;3(4):4-11.
Lurain JR. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstetr Gynecol. 2010;203(6):531-9.
Gerulath A. Gestational trophoblastic disease. SOGC Clinical Practice Guidelines. 2002;114.
Talati NJ. The pattern of benign gestational trophoblastic disease in Karachi. J Pakistan Med Assoc. 1998;48:296-9.
Buckley JD. The epidemiology of molar pregnancy and choriocarcinoma. Clin Obstet Gynecol. 1984;27(1):153-9.
Bagshawe KD. Risk and prognostic factors in trophoblastic neoplasia. Cancer. 1976;38(3):1373-85.
Remy JC, McGlynn M, McGuire J, Macasaet M. Trophoblastic disease:20 years’ experience. Int J Gynaecol Obstet. 1989;28(4):355-60.
Ayhan A, Tuncer ZS, Halilzade H, Küçükali TJ. Predictors of persistent disease in women with complete hydatidiform mole. Reprod Med. 1996;41(8):591-4.
Parazzini F, Vecchia CL, Mangili G, Caminiti C, Negri E, Cecchetti G, et al. Risk factors of GTD. Am J Obstet gynecol. 1992;78(6)1039-45.
Aziz MF, Kampono N, Moegni EM, Sjamsuddin S, Barnas B, Samil RS. Epidemiology of gestational trophoblastic neoplasm at the Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Adv Exp Med Biol. 1984;176:165-75.
Stone M, Bagshawe KDBr. An analysis of the influences of maternal age, gestational age, contraceptive method, and the mode of primary treatment of patients with hydatidiform moles on the incidence of subsequent chemotherapy. J Obstet Gynaecol.1979;86(10):782-92.
Park TK, Kim SN, Lee SKY. Analysis of risk factors for postmolar trophoblastic disease: categorization of risk factors and effect of prophylactic chemotherapy. Onsei Med J. 1996;37(6):412-9.
Grazybowski W. Risk factors for gestational trophoblastic tumours followimg complete hydatidiform mole. Ginekol Pol. 2002;73(11):1003-10.
Rob L, Robová H, Pluta M, Kulovaný E, Hrehorcák M, Chmel R, et al. Regression of hCG in various types of molar pregnancies-clinical course and prognosis.Ceska Gynecol. 2001;66(4):230.
Niemann I, Petersen LK, Hansen ES, Sunde L. Predictors of low risk of persistent trophoblastic disease in molar pregnancies. Obstet Gynecol. 2006 May;107(5):1006-11.
