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Hesham Sait 6th Medical student ,Faculty of medicine
King Abdulaziz University Hospital
Disclosure
I have nothing to disclose.
Gestational Trophoblastic Disease(GTD)
It is an abnormal condition of the ovum where there are partly degeneration and partly hyperplastic changes in the young chorionic villi, these result in the formation of small cysts of varying size.
Gestational Trophoblastic Disease (GTD)
Pre-Malignant
Complete Mole
Partial Mole
Malignant
Invasive mole
Choriocarcinoma
Placental site trophoblastic tumorsSeckl et al Lancet 2000 and palmeiri et al Lancet 2005
Worldwide incidence of molar pregnancy
Regions Incidence/1000 pregnancies
North America and Europe 0.5–1
Asia and Middle East 1–12
Saudi Arabia 0.94–2.2
South Africa 0.87–4.88
West Africa and Nigeria 1.26
∗ To estimate the prevalence of (GTD) in the western region of Saudi Arabia.
∗ To evaluate the success of treatment and the effect of age and risk group on survival.
∗ Retrospective Coherent study.
∗ All patients treated for GTD between January 2001and December 2010 were identified using KAUH data base.
∗ Medical record was reviewed for age, parity, clinical presentation and treatment outcome.
∗ Data entered in SPSS v20.
∗ Survival of patients with GTN were calculated using Kaplain Mayer Test and Cox Regression were used for independent variable.
∗ Patients with persistent disease were evaluated according to their clinical treatment outcomes.
∗ Ethical approval were obtained.
Results
Demographic data of patients (n = 122)Variable n
Age (years)Mean ± SD (range) 31.52 ± 10.8 (15–56)
ParityMedian (range) 3 (0–7)
Gestational age (weeks)Mean ± SD (Range) 12.42 ± 3.2 (4–22)
Pre-evacuation level of hCG<100,000 u/ml>100,000 u/ml
30 (25%)92 (75%)
Median follow-up(months)Range
2412–72
Number %
SuctionEvacuatio
n71 92.2
Hysterectomy
6 7.8
Summary of patients who underwent hysterectomy as initial
treatment Case
Age (years)
Parity (n) Pathology
1 52 10 Complete mole
2 45 7 Complete mole
3 54 10 Complete mole
4 49 7 Complete mole
5 47 7 Complete mole
6 54 9 Complete mole
Persistent GTD %
Partialmole
1 1.3
Complete mole
19 24.6
All 20 25.9
Criteria used to diagnosed GTN
Plateauing of HCG level over at least three weeks.A 10% or greater rise in HCG for three or more values over at least two weeks.Persistent of HCG six months after molar evacuation.
All had two more cycles after zero HCG
All had one more cycle after zero HCG
1st case: High risk GTN died 24 hours after admission to ICU because of respiratory failure.
2nd case: low risk died from RTA few years after initial treatment of Mtx.
3rd case: low risk died from chemotherapy toxicity thought to be high risk was treated with MAC.
Kaplain Mayer Test Comparison Wilcoxon Test P=0.69 (N/S)
Over-all 5 year survival98%
P=0.49
∗ We report the first survival data for GTN in Saudi Arabia. However, the overall incidence of GTD in Saudi Arabia will be better defined by establishment of a GTD registry.
Acknowledgment
• Prof. Khalid Sait• Dr. Nisren Anfnan• Prof. Basem Aldeek
Thank You..