Role of ultrasound in the diagnosis and management of gestational trophoblastic disease in Rwanda Rural health facilities- A case report

Abstract

Introduction Gestational trophoblastic disease (GTD) is a rare kind of proliferative disorder of trophoblastic cells which develops from the placenta in early pregnancy and the complete hydatidiform mole (CHM) sub-type which limited to endometrium is most common. It has excellent prognosis if early appropriate diagnosis and management are done. A well performed ultrasound(US) play a primordial role in the diagnosis of maternal health disorders during routine prenatal care. This helps in avoiding complications and consequently aids in achieving the objectives of the Millennium Development Goals (MDGs) in Rwanda. Aim To understand the definition of Gestational trophoblastic disease(GTD); To recognize key diagnostic findings of complete molar pregnancy on ultrasound and appropriate management in maternal follow up and To review the differential diagnosis for ultrasound findings seen with GTD. Methods The case has been referred in ultrasound unit for scan from outpatient department and follow up US was ordered and done during management period while the patient lies on a bed while operator moves the 3,5 MHz lubricated transducer of frequency with gel on the abdomino- pelvic region with full urinary bladder and Mindray ultrasound Machine has been used. Results There was a large moderately hyperechogenic mass completely filling the endometrial cavity with numerous small cystic spaces of different size. Post 5 days under treatment, anechoic area within endometrial cavity and myometrium well outlined was discharged and in 3rd medical visit after 2 weeks, US were normal. Conclusion Ultrasound is the first modality to be used in all rural health facilities for diagnosis of suspected Gestational trophoblastic disease (GTD) for better results. It is available and free of radiation. Recommendation -The US is the baseline modalities to be used in 1st trimester in pregnancy women with GTD suspicion bleeding. -All rural health facilities should have empowered and capable trained Medical imaging practitioners for appropriate carrying out the ultrasonographic investigation for better care service delivery on GTD(Medical imaging practitioners Role extension project after formal training by Prof. Kawooya).