Incidence Of Gestational Trophoblastic Disease Research Articles

Low-risk gestational trophoblastic neoplasia - 20 years experience of a state registry.

Gestational trophoblastic disease (GTD) is an uncommon but highly treatable condition. There is limited local evidence to guide therapy. To report the experience of a statewide registry in the treatment of low-risk gestational trophoblastic neoplasia (GTN) over a 20-year period. A retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low-risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed. The incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0-29 days). Seventy-seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi-agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5-6 (odds ratio (OR) 6.56, 95% CI 1.73-24.27, P = 0.005) and those with pre-treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73-24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry. Methotrexate is a highly effective treatment for low-risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5-6 requires further investigation.

SAT494 Impending Thyroid Storm during Pregnancy in a Patient with Gestational Trophoblastic Disease

Abstract Disclosure: R. Kulkarni: None. Z. Sibai: None. Background: Gestational trophoblastic disease (GTD) is a rare complication of pregnancy that arises due to abnormal proliferation of trophoblasts of the placenta. The incidence of GTD in the United States of America is about 110 to 120 per 100,000 pregnancies. Abnormal trophoblastic proliferation leads to higher than expected B-HCG levels compared to normal pregnancy. Since the beta subunit of β-hCG has similar structure to TSH, β-hCG stimulates TSH receptor and causes hyperthyroidism during pregnancy which can be asymptomatic, mild or it can lead to severe cases of thyroid storm. Clinical Case: A 19-year-old African American woman with no PMH, 8 weeks primigravida presented with complaints of nausea, abdominal pain and difficulty walking. Associated symptoms included blurry vision, excessive sweating, tremors and palpitations. Physical examination finding included sinus tachycardia and low BMIof 18.6kg/m2, bilateral hand tremors, weakness of bilateral lower extremities. Initial labs showed quantitative β-hCG level of 283,163(H) m(iU)/mL, TSH <0.010 (L) m(iU)/L , FT4 2.54 (H) ng/dL, negativeTSI and TPO Abs. Burch-Wartofsky Point Scale score was 35 suggestive of impending thyroid storm. Pelvic ultrasound showed intrauterine pregnancy with estimated gestation age of 7 weeks 3 days with findings suggestive of fetal demise. Patient underwent Dilatation and Curettage for suspected molarpregnancy. Final histopathological report of aborted specimen verified the diagnosis of partial molar pregnancy. Based on clinical history, physical finding and lab results, patient was diagnosed with gestational trophoblastic disease induced impending thyroid storm. Endocrinology initiated management with Propranolol 40 mg TID and Methimazole 10 mg daily withimprovement in her clinical symptoms in two days. One week follow up as an outpatient showed resolution of symptoms, normalization of free T4 and down trending β-hCG titers to 166 m(iU)/mL. Propranolol and methimazole were stopped. Conclusion:Gestational trophoblastic disease although a rare clinical entity, it is potentially a life-threatening condition. β-hCG is a glycoprotein, and its beta subunit is structurally similar to TSH, allowing it to bind to the TSH receptor and causing hyperstimulation of the thyroid follicular cells leading to various degrees of hyperthyroidism. GTD associated with significant high level of β-HCG, in rare cases can cause severe consequences like thyroid storm. Therefore, GTD should be considered as a differential diagnosis in patient’s presenting with sever thyrotoxicosis during pregnancy. The mainstay of management is evacuation of the molar pregnancy. In severe cases of hyperthyroidism, Beta blocker and thioamides can be considered for symptoms relief and to speed the recovery. Follow-up with serial quantitative β-hCG measurements is crucial to evaluate for persistent molar tissue. Presentation Date: Saturday, June 17, 2023

A One-Year Epidemiological Perspective of Molar Pregnancies at Orotta Maternity Referral Hospital: Asmara, Eritrea

Gestational trophoblastic diseases (GTD) are a group of diseases originating from the placenta, with significant morbidity and mortality, especially in developing countries. A one-year prospective study on GTD was done to determine the incidence of GTD identify the risk factors; explain the clinical presentation; describe the management; and record the outcomes at Orotta Maternity Referral Hospital (OMRH) Asmara, Eritrea; A protocol for the prospective study of GTD was prepared with involvement of colleagues. All collected data was reviewed and finalized by the author. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS). During the study period a total of 6845 deliveries and 45 cases of GTD were recorded at OMRH. This gives an incidence of 6.6 per 1000 deliveries. Primgravid mothers were more affected. The majority of cases were complete molar pregnancy (87%) and vaginal bleeding was the main presentation. Pregnancy test result was read as negative in 7% of cases. Of the cases followed, 77.7% recovered while 11.1% required chemotherapy because of persistent disease and 8.9% were lost to follow up. The study confirms higher incidence, of GTD in Eritrea as compared to results of some African countries. The need to strengthen histological services and quantitative serum tests were identified as crucial in the effective management of GTD at OMRH. A standard and systematic approach of diagnosis, treatment and strict fellow-up of cases is required for better outcome.

Invasive Mole With Impending Uterine Rupture : A Case Report

Gestational Trophoblastic Disease (GTD) is an abnormal placenta, composed of a spectrum of premalignant to malignant disorders. In Indonesia, GTD incidence is particularly challenging to estimate, since not all cases will be reported or recognized. It classified into hydatidose mole and gestational trophoblastic neoplasia (GTN). One of those clinicopathological classification of GTN is malignant invasive mole. It is likely to be the cause of increased maternal mortality in Indonesia if the disease is not well diagnosed and treated.We reported the case, a 28 years old woman who had a invasive mole with impending uterine rupture. She had a pervaginam bleeding symptoms since 3 weeks after post curetase due to hydatidose mole indication. She also had multiple abortus history.

A Review of Gestational Trophoblastic Disease in A Tertiary Hospital in NothWestern Nigeria

Background: Gestational trophoblastic disease (GTD) encompasses a range of pregnancy related disorders of complete and partial hydatidiform mole, and the malignant disorders of invasive mole, choriorcarcinoma and the rare placental-site trophoblastic tumour. Aims: The study is aimed to determine; (1) the prevalence of gestational trophoblastic tumours in Federal Medical Centre, Birnin Kebbi (2) The pattern of presentation and (3) the maternal outcome in patients with GTD managed at the Deparrtment of Obstetrics and Gynaecilogy of Federal Medical Centre, Birnin Kebbi, Nigeria. Methodology: This was a retrospective study of the cases of gestational trophoblastic disease managed at the Departmenrt of Obstetrics and Gynaecology of Federal Medical Centre, Birnin Kebbi, Noth-Western, Nigeria between the 1st January, 2010 and 31st of December, 2019. Results: There were 82 cases of gestational trophoblastic diseases out of 5,088 gynaecological admissions during the study period, thereby constituting 1.6% of the total gynaecological admissions. There were 16,572 deliveries; hence the incidence of GTD was 4.9 per 1000 deliveries. The age range of the patients is between 15–45years, with a mean age of 26.84 years. Of the 82-case managed during the period under review, only 74 (90.2%) of patients’ case notes were retrieved for analysis. Hydatidiform mole was the commonest among them, accounted for 56.8% of cases and 6.9% of the cases were choriocarcinoma. In 50% of cases there was no documented histological diagnosis. GTD was commoner at the extremes of reproductive age. Conclusion: The incidence of GTD in this study was 4.9 per 1000 deliveries. Vaginal bleeding was the commonest presenting symptom. Early diagnosis and appropriate treatment of this disease is a good determinant of the disease outcomes, while late presentation was associated with high maternal mortality as found in this study.

Gestational Trophoblastic Disease in Malta

Background: Gestational trophoblastic disease (GTD) is a group of uncommon conditions associated with pregnancy and includes a spectrum of premalignant to malignant disorders. The aim of this study is to determine the local incidence of GTD and to analyses the management that is being offered to patients with GTD in Mater Dei Hospital. Methodology: All patients diagnosed with GTD from 1st January 2015 till 31st December 2020 were studied. The list of patients with GTD was obtained from the Pathology Department and data was collected from medical records, iSOFT and electronic discharge summaries. Results: In this 6-year study period, 83 cases of GTD were identified. 79.5% of patients had partial hydatidiform mole and 16.9% had complete mole. 3.6% were cases of gestational trophoblastic neoplasia. 55.4% of patients received medical treatment with vaginal misoprostol and 27.7% had immediately surgical management. Their follow-up was studied; 21.7% had 3 out-patients visits or less, 33.7% had between 4 to 6 visits and 19.3% had 7 to 15 outpatients visits. 7.2% had extra oncology out-patients visits. 40% of patients had a follow-up that lasted for 7 months or more. Conclusion: GTD in Mater Dei Hospital appears to be an uncommon disease, but the local incidence was noted to be as high as 1 per 319 living births. This study demonstrated that a large number of patients were medically treated and the follow-up received was noted to be inconsistent. The care of these patients can be highly optimized by the set-up of a small dedicated clinic

Association of extended culture to blastocyst and pre-malignant gestational trophoblastic disease risk following IVF/ICSI-assisted reproduction cycles: an analysis of large UK national database.

To assess whether there is an association between extended in vitro culture based on embryo developmental stage at transfer and pre-malignant gestational trophoblastic disease (GTD) risk of molar pregnancy during assisted reproduction. A retrospective study was carried out using Human Fertilization and Embryology Authority (HFEA) anonymized register from 1999 to 2016. A total of 540,376 cycles were eligible to be included in the study after excluding any kind of donor treatment or surrogacy, frozen embryo transfers, and cycles with incomplete data. Subgroup analysis was carried out in subjects with primary infertility aiming to exclude an increased risk in those with a previous GTD. Multivariate logistic regression analysis was used to adjust for possible confounders, and the effect of day of embryo transfer in IVF (in vitro fertilization)/ICSI (intracytoplasmic sperm injection) treatment on a molar pregnancy GTD outcome was analyzed. The prevalence of a molar pregnancy GTD among the study population was 3.4/10,000 livebirths (53/156,683) with a higher risk in the over 40 age category. No significant difference of pre-malignant GTD incidence was seen between IVF and ICSI (0.01% vs 0.009% respectively). No association was seen with GTD based on type/cause of infertility or number of embryos transferred. Crude (1.06; 95% CI 0.852-1.31) and adjusted (1.07; 95% CI (0.857-1.32) odds ratios were calculated to see an association between day of embryo transfer and the occurrence of a GTD. There was no association between day of embryo transfer and molar GTD risk after adjusting for age and secondary infertility. No significant association between pre-malignant molar gestational trophoblastic disease and extended in vitro embryo culture was found after analyzing 540,376 cycles of IVF and ICSI.

Epidemiologic study on gestational trophoblastic diseases in Japan.

This study aims to estimate the population-based incidence of gestational trophoblastic diseases (GTDs) and to identify the characteristics of gestational trophoblastic neoplasia (GTN) in Japan. The annual number of GTD and live births from 1974 to 2018 were used to estimate the incidence of GTD. The data of 1,574 GTN cases from 1999 to 2018 were analyzed to identify the characteristics of low-risk GTN, high-risk GTN, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). The incidence of hydatidiform mole was 2.02 per 1,000 live births on average which decreased from 1974 to 2008 and increased from 2009 to 2018. The incidence of low-risk GTN, high-risk GTN, PSTT, and ETT was 15.3, 3.5, 0.3, and 0.07 per 100,000 live births, respectively. The estimated incidence of post-molar GTN was 9.8% of molar patients. High-risk GTN was diagnosed more pathologically, had more various kinds of antecedent pregnancies, and had longer intervals after the antecedent pregnancy compared to low-risk GTN. Furthermore, 8.2% of high-risk GTN occurred after the subsequent non-molar pregnancy of hydatidiform mole. The cumulative percentage of developing high-risk GTN after hydatidiform mole reached 89.3% at the 60th month. The incidence of hydatidiform mole, low-risk GTN, high-risk GTN was 2.02 per 1,000 live births, 15.3 per 100,000 live births, and 3.5 per 100,000 live births, respectively. High-risk GTN was diagnosed more pathologically and later after the antecedent pregnancy than low-risk GTN. Following molar patients for five years is needed to improve the mortality of malignant GTN.

The current situation of health services for hydatidiform mole in Cambodia

Management of hydatidiform mole is important to reduce the mortality and morbidity of choriocarcinoma. This study aims to understand the existing health services for hydatidiform mole and to estimate the incidence of gestational trophoblastic disease (GTD) in Cambodia. A questionnaire was used to collect information on the existing health services for pregnancy and hydatidiform mole at health facilities from attendants of the 16th Annual Conference of the Cambodian Society of Gynecology and Obstetrics in 2017. The incidence of GTD in 2014-2017 was estimated using Health Information System data. A total of 126 attendants, who were from all provinces except three provinces, answered the questionnaire. The work places were national hospitals (n=29), provincial hospitals (n=42), district hospitals (n=20), health centers (n=6), and others (n=29). The answers of participants from the public sector suggested the following: Ultrasonography is available at all hospitals but not health centers; Human chorionic gonadotropin (hCG) measurement is only available at national hospitals; Treatment of hydatidiform mole is performed at national hospitals and provincial hospitals; and Treatment of gestational trophoblastic neoplasia (GTN) is provided at national hospitals. The incidence of hydatidiform mole and GTN at health facilities in the public sector in 2014-2017 was 0.95 per 1000 deliveries and 6.58 per 100 000 deliveries, respectively. The results suggest that provincial hospitals are important to detect suspected invasive mole and refer to national hospitals for diagnosis and treatment. Further studies on the management of GTD and development of the guidelines of GTD are needed.

A Five-Year Retrospective Study of Gestational Trophoblastic Disease at University of Maiduguri Teaching Hospital Maiduguri, Nigeria

Background: Gestational trophoblastic disease (GTD) is an uncommon complication of pregnancy. It is of clinical and epidemiological interest partly because of its good prognosis if detected and managed early. Objective: This study was to determine the prevalence, clinical presentation, management outcome and histologic types of GTDs at University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Methodology: A five-year retrospective study of histologically confirmed cases of GTDs managed in UMTH was undertaken. Folders of patient treated for GTD during the study period served as source of data. Statistical analysis was done using Statistical Package for the Social Sciences. Results: There were a total of 47 (38 molar and 9 choriocarcinoma) cases of GTDs that were diagnosed and managed at UMTH. However, only 40[31(77.5%)] molar and [9(22.5%) choriocarcinoma] case files were retrieved. 55% of the GTDs were complete hydatidiform mole, 22.5% partial hydatidiform mole and 22.5% choriocarcinoma. There was no case of invasive mole or placental site trophoblastic tumour noted. There were 15,426 deliveries in UMTH during this period giving the incidence of GTDs as 3.0 per 1000 deliveries or 1 in 328deliveries. The mean (SD) age of the patients was 30.5 ± 5.6years. Only 3(7.5%) of the patients were below 20 years of age and those who were at least 40 years of age constituted 8(20%). Low parity constituted 62.5% of the patients while 12.5% and 2.5% were nullipara and primipara respectively. The mean gestational age (SD) at presentation was 16.5±6.2 weeks. The common clinical presentations were amenorrhoea (100.0%), abnormal vaginal bleeding (97.5%), lower abdominal pain (90%) and passage of grape-like vesicles (45.0%). Only 6(15.0%) complied with the follow-up protocol for one year, while 25(62.5%) of the patients did not observe the follow-up protocol. Anaemia was the commonest complication observed. Conclusion: Gestational trophoblastic disease is relatively common in our center with an incidence of 3.0 per 1000 deliveries and 1.48% of our gynaecological admissions. Adequate patient counseling and compliance to follow-up are recommend for good outcome. Keywords: Prevalence, gestational trophoblastic disease, Hydatidiform mole, Choriocarcinoma, Maiduguri.

High Incidence of Gestational Trophoblastic Disease in a Third-Level University-Hospital, Italy: A Retrospective Cohort Study.

Introductionto assess incidence, prognosis and obstetric outcome of patients treated for gestational trophoblastic disease GTD in a twenty-year period. Incidence, prognosis and obstetric outcome of gestational throphoblastic diseaseMethodsretrospective study.ResultsFifty-four cases of GTD: 46 (85.18%) cases of Hydatidiform mole (HM); 8 cases of Persistent Gestational Trophoblastic Neoplasia (GTN) (14.81%): 6/8 cases (75%) GTN not metastatic; 2/8 cases (25%) GTN metastatic. In both cases, the metastases occurred in the lungs. In 3 out of 8 GTN cases (37.5%) a histological picture of choriocarcinoma emerged. The incidence of GTD cases treated from 2000 to 2020 was 1.8 cases per 1000 deliveries and 1.3 cases per 1000 pregnancies. Of the 54 patients, 30 (55.56%) presented showed normal serum hCG levels without the need for chemotherapy. On the other hand, 24 patients (44.44%) developed a persistent trophoblastic disease and underwent adjuvant therapy. The negative prognostic factors that affected the risk of persistence of GTD were: serum hCG levels at diagnosis > 100,000 mUI/ml; characteristic “snow storm” finding at the ultrasound diagnosis; a slow regression of serum hCG levels during follow-up; the persistence of high serum hCG levels (especially if > 1000 mUI/ml one month after suction curettage) that was the main risk factor for resistance to first-line chemotherapy. There were 10 pregnancies in total following treatment. Patients’ survival in our study was 100%.DiscussionAlthough GTD is a rare disease, its incidence was 1.3 cases per 1,000 pregnancies in Sardinia, Italy, higher if compared with mean national and worldwide incidence.

A Case Control Study on Selected Maternal Risk Factors of Molar Pregnancy

Background: The incidence of gestational trophoblastic disease varies dramatically in different regions of the world. While there are some geographical and racial variations, perhaps a higher incidence in Africa and Asia. The high incidence of molar pregnancy in some populations have been attributed to nutritional and socioeconomic factors. Some maternal biological factors also associated with molar pregnancy. This study aims to explore the various maternal risk factors associated with molar pregnancy.
 Methods: This case control study was carried out among 50 molar and 100 non-molar pregnant mothers admitted at in patient department of obstetrics and gynecology, Rajshahi Medical College Hospital from January to December 2011. The patients of molar pregnancies were selected on the basis of clinically diagnosed confirmed by ultrasonogram and histopathological examination. Controls group were selected as pregnant women of 1st & 2nd trimester. With the ethical approval from the institutional review board (IRB), patients were selected after taking their written consent. A structured questionnaire and a check list were designed with considering all the variables of interest.
 Results: Out of 50 cases 48% belongs to the age group below 20 years, 17% belongs to the age group above 34years. 88% of the control groups are belongs to the age group 20-34 years. Out of 50 cases 4% had history of prior molar pregnancy, none of the control groups had prior history of mole. 46% of molar cases belongs to the blood group A, 82% in case group and 86% of control group were hormonal contraceptive users. Among the socio-demographic risk factors occupation, education, socioeconomic condition, nutritional status of the case and control group were included.
 Conclusion: Molar pregnancy largely remains as etiologic dilemma. No pregnancy is immune to develop as hydatidiform mole. As the risk factors for the disease are unclear, an attempt has been made to identify some risk factors of molar pregnancy to compare them with normal pregnancy to find out any modifiable factors.
 JOPSOM 2020; 39(2): 34-39

Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America

BackgroundSouth America has a higher incidence of gestational trophoblastic disease than North America or Europe, but whether this impacts chemotherapy outcomes is unclear. The purpose of this study was to...

Gestational Trophoblastic Disease: A Hospital-Based Prospective Study to Characterize Incidence, Risk Factors, Management and Review of Literature

This study was conducted to prospectively evaluate the incidence of gestational trophoblastic disease (GTD) and characterize the host factors, risk factors, histology, management and follow-up in a tertiary care hospital in Mysore, India. All patients diagnosed with hydatidiform mole in the hospital during July 2011 to December 2012 were enrolled and followed up for 6 months from the date of surgical evacuation. A systematic review of literature related to epidemiology of GTD published between 2000 and 2019 was performed. A total of 52 women were diagnosed to have GTD with 20,385 live births reported in the same duration. The mean age at presentation was 21.56 ± 2.9 years (range 18–30). Mean gestational age at presentation was 12.40 ± 4.1 weeks. Histopathology revealed 53.8% partial hydatidiform mole, 44.2% complete hydatidiform mole, and 1.9% invasive mole. The median duration to reach normal beta-hCG levels was 8 weeks (range 6–12 weeks). Suction evacuation was the primary mode of treatment. Three (5.8%) patients were diagnosed with gestational trophoblastic neoplasia. The incidence of GTD in the study was 2.6 per 1000 live births. There is a large variation in the incidence rates reported from India, and they are generally higher than the rates reported from Europe and the USA and consistent with other Asian studies. The host factors and the follow-up requirements characterized in the study will help design future population-based studies.

BRCA1 promoter hypermethylation in human placenta: a hidden link with β-hCG expression.

Gestational trophoblastic diseases (GTD) are group of pregnancy-related tumors characterized by abnormal levels of 'β-hCG' with higher incidence in South-East Asia, especially India. Our laboratory has reported that wild-type BRCA1 transcriptionally regulates β-hCG in triple negative breast cancers (TNBCs). These factors culminated into analysis of BRCA1 status in GTD, which would emanate into elucidation of BRCA1- β-hCG relationship and unraveling etio-pathology of GTD. BRCA1 level in GTD is down-regulated due to the over-expression of DNMT3b and subsequent promoter hypermethylation, when compared to the normal placentae accompanied with its shift in localization. There is an inverse correlation of serum β-hCG levels with BRCA1 mRNA expression. The effects of methotrexate (MTX), which is the first-line chemotherapeutic used for GTD treatment, when analyzed in comparison with plumbagin (PB) revealed that PB alone is efficient than MTX alone or MTX-PB in combination, in showing selective cytotoxicity against GTD. Interestingly, PB increases BRCA1 levels post-treatment, altering DNMT3b levels and resultant BRCA1 promoter methylation. Also, cohort study analyzed the incidence of GTD at Sree Avittom Thirunal (SAT) Hospital, Thiruvananthapuram, which points out that 11.5% of gestational trophoblastic neoplasia (GTN) cases were referred to Regional Cancer Centre, Thiruvananthapuram, for examination of breast lumps. This has lend clues to supervene the risk of GTD patients towards BRCA1-associated diseases and unveil novel therapeutic for GTD, a plant-derived naphthoquinone, PB, already reported as selectively cytotoxic against BRCA1 defective tumors.

Thyroid function among women with gestational trophoblastic diseases. A cross-sectional study.

Gestational trophoblastic diseases (GTDs) are treatable rare tumors with wide distribution. The estimated incidence of GTDs varies dramatically between different regions globally. In early pregnancy, there may be high human chorionic gonadotropin (HCG) concentrations, normal or slightly increased free T4 (fT4) and subnormal thyroid-stimulating hormone (TSH), causing hyperthyroidism ranging from subclinical to severe. Beta-HCG causes thyrotoxicosis through thyroid stimulation in patients with trophoblastic tumors. To assess thyroid function among patients diagnosed with complete or partial hydatidiform mole, within the GTD spectrum. Cross-sectional study based on patients' medical records at Van University Hospital, Van, Turkey. 50 patients monitored due to diagnoses of hydatidiform mole were included and were examined regarding thyroid function. Thyroid gland size and volume were measured using thyroid ultrasonography. Beta-HCG, TSH, fT4, free T3 (fT3), total T4 (TT4), total T3 (TT3), anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG) and thyroglobulin levels were measured. Among these patients, 15 (30%) were diagnosed with complete hydatidiform mole and 35 (70%) with partial hydatidiform mole, according to pathology results. Those with complete hydatidiform mole were older (P = 0.003), with higher number of pregnancies (P = 0.032), lower TSH level (P = 0.011) and higher fT4 and TT4 levels (P = 0.04; P = 0.028), compared with partial hydatidiform mole patients. In hydatidiform mole patients, thyroid disease severity increases with age, parity, beta-HCG level and mole size. However, prospective multicenter studies on this topic are needed, with larger numbers of patients and closer monitoring.

Incidence of gestational trophoblastic disease in South Korea: a longitudinal, population-based study.

IntroductionWe investigated the rate and longitudinal trends of gestational trophoblastic disease (GTD) incidence in the Republic of Korea between 2009 and 2015 using population-based data.Materials and MethodsData of patients diagnosed with GTD from 2009 to 2015 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample (HIRA-NIS) in the Republic of Korea. The HIRA annually provides the HIRA-NIS, a collection of clinical data from over one million people. For each year, the HIRA-NIS extracted records of 13% of patients admitted at any one time during the year and 1% of all remaining patients using the weighted sample method.ResultsMedical records of 370,117 women with at least one pregnancy (GTD, ectopic pregnancy, abortion, or delivery) were extracted from a total of 4,476,495 records. Of these, 372 episodes of GTD were identified in women with a mean age of 35.4 ± 0.7 years. The incidence rate of GTD was 130 ± 10 cases per 100,000 pregnancies, which was classified as hydatidiform mole (HM), invasive mole, or malignant neoplasm of the placenta with incidence rates of 110 ± 10, 20 ± 0, or 10 ± 0 cases per 100,000 pregnancies, respectively. Incidence of GTD was lowest among women in their late 20 s and early 30 s. Occurrences of HM accounted for 80.3% all GTD cases. Weighted logistic analysis indicated that while age significantly affected the incidence of GTD (odds ratio (OR): 2.46; 95% confidence interval (CI) [1.79–3.37]; P < 0.001), socioeconomic status did not (OR: 1.94; 95% CI [1.0–3.79]; P = 0.05).ConclusionsIn the Republic of Korea, we observed overall incidence rates of GTD and HM of 1.3 and 1.1 per 1,000 pregnancies, respectively, which are similar to those reported in recent Western population-based studies. We also noted that annual incidence rates of GTD stabilized from 2009 to 2015.

Gestational Trophoblastic Diseases: A Review of the Clinical Presentation and Management at the Alex Ekwueme Federal University Teaching Hospital Abakaliki

Background: Gestational trophoblastic diseases (GTD) are potentially curable with retention of reproductive function once the correct diagnosis is made and treatment is commenced early with adequate follow up. Objective: The objective of this study was to determine the incidence, clinical presentation, management and treatment outcomes of gestational trophoblastic diseases in a tertiary hospital in Abakaliki, South-east Nigeria. Materials and Methods: This was a retrospective descriptive study of gestational trophoblastic diseases managed at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA) over a 6-year period. The statistical analysis was done using SPSS version 22. Results: The incidence of GTD was 4.6 per 1000 deliveries. Women who were less than 20 years and more than 40 years of age accounted for 5.9% and 23.5% of cases of GTD respectively. Women who were para 5 and above accounted for 76.5% of those who presented with GTD. All the patients presented with vaginal bleeding. Suction evacuation (76.5%) was the commonest form of treatment offered to women with GTD. The commonest complication was anaemia (94.1%). Maternal death due to GTD was 8.8%. Most (58.8%) of the patients did not turn up for follow-up. Conclusion: Gestational trophoblastic diseases has remained an important cause of maternal morbidity and mortality in our hospital due to poor compliance with follow-up. Call and recall system should be introduced in the management of patients with GTD to improve compliance to management standard.

Is there uniformity in definitions and treatment of gestational trophoblastic disease in Europe?

Because gestational trophoblastic disease is rare, little evidence is available from randomized controlled trials on optimal treatment and follow-up. Treatment protocols vary within Europe, and even between different centers within countries. One of the goals of the European Organization for Treatment of Trophoblastic Diseases (EOTTD) is to harmonize treatment in Europe. To provide a basis for international standardization of definitions, treatment and follow-up protocols in gestational trophoblastic disease, we evaluated differences and similarities between protocols in EOTTD countries. Members from each EOTTD country were asked to complete an online structured questionnaire comprising multiple-choice and multiple-answer questions. The following themes were discussed: incidence of gestational trophoblastic disease and gestational trophoblastic neoplasia, definitions, guidelines, classification system, treatment, recurrence, and follow-up. Forty-four respondents from 17 countries participated in this study. Guidelines were present in 80% of the countries and the FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) staging and risk classification was often used to estimate risks. Agreement about when to start chemotherapy for post-molar gestational trophoblastic neoplasia was present among 66% of the respondents. Preferred first-line treatments in low- and high-risk gestational trophoblastic neoplasia were methotrexate (81%) and EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) (93%), respectively. The definition of human chorionic gonadotropin normalization after hydatidiform mole evacuation was two consecutive normal values for nine countries. The FIGO definition of post-molar gestational trophoblastic neoplasia based on human chorionic gonadotropin plateau or rise was agreed on by 69% of respondents, and only 69% and 74% defined low-risk and high-risk disease, respectively, using FIGO criteria. There were major differences in definitions of recurrence, chemotherapy resistance and follow-up protocols among countries, despite EOTTD consensus statements. This questionnaire provides a good overview of current clinical practices in different countries. Based on the survey results, it is clear that there are several gestationaltrophoblastic disease-related topics that need urgent attention within the EOTTD community to create more uniformity and to aid the development of uniform guidelines in Europe.

Incidence and clinicopathological profile of gestational trophoblastic disease in tertiary care centre

Introduction: Gestational trophoblastic disease (GTD) arises from abnormal proliferation of placental trophoblastic tissue. The aim of this study was to determine the incidence and clinicopathological profiles with treatment outcome of gestational trophoblastic disease in Jigme Dorji Wangchuck National Referral Hospital, a tertiary hospital in Bhutan.&#x0D; Method: A prospective and retrospective observational study was conducted over a period of 18 months.&#x0D; Results: A total of 121 cases of gestational trophoblastic disease were diagnosed with an incidence rate of 19.7 per 1000 deliveries. Majority comprised hydatidiform moles(115);of which, 30 (26.1%) were complete and 85(73.9%) partial moles. The mean gestational age at diagnosis of hydatidiform mole was 9.8± 1.6 weeks and the most common symptom being vaginal bleeding (72.8%). Nine (7.8%) of these progressed to gestational trophoblastic neoplasia and was strongly associated with high pre-evacuation beta-hCG level (&gt; 100,000 mIU/ml) and larger uterine size (&gt; 14 weeks).&#x0D; Conclusions: This study revealed a high incidence of gestational trophoblastic disease in national referral hospital. Further in-depth research and instituting a GTD registry can be useful to validate these findings and find the true incidence. A substantial number of molar pregnancies can progress to GTN, and thus requires strict follow-up.