Prevalence and clinical observations of Gestational Trophoblastic Diseases in Maternity Teaching Hospital in Erbil City

摘要

Gestational Trophoblastic Diseases (GTDs) are uncommon chorionic tumor of the placenta. It includes a spectrum of diseases from the usually benign hydatidiform mole to the highly malignant choriocarcinoma. A descriptive observational study carried out on 40 cases with GTDs to determine the rate, epidemiological correlates, clinical behavior, and common complications of the disease. The study done on pregnant women admitted to Maternity teaching hospital, Erbil city, North of Iraq, Kurdistan region during the period from 1st October 2008 to the 1st of April 2009. Demographic data were collected from each patient, history of prior molar pregnancy, socioeconomic state, presenting signs and symptoms, complete examination and investigation done for all of them, elevated level of Human chorionic gonadotrophin hormone, was used to diagnose the condition also ultrasonography with a special findings to GTDs done for every patient. The incidence of GTD was 1 in every 318 pregnant women. The highest incidence was in 40 years old women and more. The mean age of the study sample was 27.97+8.66 years, sixty two percent of cases were in the age group of 20-39 years, the mean gestational age was 11±3.7 weeks, 65% of cases were presented in the first trimester, while 35% of cases were in second trimester. 82.5% of cases were complete mole, 10% were partial mole, and 7.5% were gestational trophoblastic neoplasm. Majority of cases (87.5%) presented with vaginal bleeding, pregnancy induced hypertension and preeclampsia was the presentation in 15% of cases, 67.5% had abdominal cramps, 50% presented with signs od dehydration due to hyperemesis gravidarum, 25% had hyperthyroidism, there was a statistically significant association between hyperemesis gravidarum and hyperthyroidism. Theca lutein cysts presented in 25% of the cases. The uterine fundal level was larger than the gestational age in 45% of the cases. There was a statistically significant association between the Gestational Trophoblastic Neoplasia and the presence of theca lutein cysts and history of molar pregnancy in the antecedent pregnancy but there was no significant association between the gestational trophoblastic neoplasia and the age groups. Ultrasound was diagnostic in 38 cases (95%), while histopathological examination was diagnostic in 100% of the cases. Complications of the GTD; such as infections, trophoblasic embolism, and uterine perforation were not found in the current study. The incidence of GTDs in Maternity teaching hospital (1 in 318) is comparable to the incidence in some Middle East and Far Eastern countries.