Clinical Analysis of Molar Pregnancy

Abstract

Background: Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases. Molar pregnancy is one of the causes of maternal morbidity and mortality among women in the reproductive age group. However the magnitude, clinical features and risk factors are not well documented in our country .This study was conducted to describe these aspects of the disease entity in one tertiary level hospital. Objective: to determine the frequency and evaluate the current clinical characteristics of patients with molar pregnancy in Bangladesh. Study design: this was a cross sectional observational study. Study place and period: Department of Obstetrics and Gynaecology in BSMMU, Dhaka. Study period from January 2015 to June 2015. Study population: Patients with molar pregnancy admitted in the department of Obstetrics and Gynaecology in BSMMU during the study period. Outcome variables: Varieties of clinical presentation, diagnosis and treatment modalities. Results: The incidence of molar pregnancy was 7.3 per thousand pregnancies in BSMMU hospital during the study period. The age of the patient ranged from 18-47 years, with maximum 65% between 21-40 years age group. Only 5% patients were above the age of 40. Majority 65% of patients were multigravida while 35% were primigravida. Maximum 85% of all were from low socio-economic group. In 40% patient's blood group was B+ve and A+ve in 25% patients. Abnormal vaginal bleeding was the commonest presenting symptoms in 60% patients. Other than that 15% patients came with vaginal bleeding and passage of vesicles, 12.5% with lower abdominal pain, 7.5% patients had no symptom except amenorrhea diagnosed incidentally and other 5% had amenorrhea with exaggerated sign symptom of pregnancy. More than two third (80%) of the patients had uterus more than the period of gestation. USG, serum ß-hCG and CBC was done in all the cases. Chest X- ray was done in 60% cases. Serum ß- hCG level was found above the level of 50000 in 80% cases. Different modalities of treatment such as suction evacuation, D&C and hysterectomy were used for the patients with molar pregnancy. Suction evacuation was the first line treatment in 87.5% patients of molar pregnancy & follow up should be done at least for 6 months. Conclusion: Molar pregnancy is the disease of women in their reproductive years. It was commonly found in young multipara women of below average income group. Most common clinical manifestation was vaginal bleeding. Diagnosis was confirmed by ultrasonography and serum ß-hCG. Patients with molar pregnancy have the risks of developing persistent gestational trophoblastic disease (GTD) and should be followed up. It is now indispensible to set up a nationwide accepted protocol for the early detection and management of patient with molar pregnancy as well as to initiate a structured follow up programme to observe the prognosis of the disease.