A descriptive study of gestational trophoblastic disease in four major hospitals in Kampala Uganda

Abstract

Background.Gestational trophoblastic disease is unusual complication of pregnancy were by abnormal placental tissue proliferates in the absence of a viable fetus. There is usually a protracted follow-up period were pregnancy is contra-indicated. Whilst a description of the disease has been done in the developed world, little information is published/known about the disease and its variants especially in Uganda yet it is associated with high mortality and morbidity if not well managed. Objective: This study aimed to describe the burden (prevalence), clinical features and document management of gestational trophoblastic disease and its variants in four major hospitals in Kampala Uganda. Methods: This was a cross sectional Period prevalence study in the four major hospitals in Kampala Uganda (Mulago hospital,Nsambya hospital, Mengo hospital,Lubaga). Ethical approval for the study was granted by school of medicine research and ethics Committee of Makerere university and the four major hospital Administration. The study was conducted from 1st January 2014 to 30th June 2014 on 168 participants. Participants with a diagnosis of gestational trophoblastic disease who fulfilled the eligibility criteria and those whose parents gave informed consent participated in the study. The Patient’s bio data (identification information), presenting complaints, B-HCG levels, ultra sound findings and histology results were recorded and the management documented. The Data was coded and entered into a computer using EPI data version 3.2 software and then exported into STATA version 10 for analysis. xi Results. The overall prevalence of gestational trophoblastic disease in the study population was 7 per 1000 deliveries. Hydatidform mole accounted for the majority of GTD 68.9% while Invasive mole accounted for the least at 0.6%. A total of 25613 deliveries were recorded in the six months. Most of the deliveries were in Mulago Hospital (65.6%) followed by Nsambya Hospital (13.2%) and least in Lubaga Hospital (11.3%). The Mean age of the study participants was 27.8 years (Standard deviation ± 7.8 years) with most of them being in the reproductive years, < 40years (87.5%). Extremes of age, <20years and >40years (26.2%) continued to be risk factor for GTD. The majority of participants presented with vaginal bleeding (61.9%), however 2.4% presented with failure of pregnancy progression. Duration from antecedent pregnancy was < 4 months (70.7%) in most of the patients followed by > 12 months (19.5%). Hydatidform mole was the commonest type of antecedent pregnancy (51.2%) while 41.5% of participants we didn’t know the type of antecedent pregnancy they had. Of the participants who had histology done(48.2%), the commonest histological finding was complete mole(22.0%),partial mole(10.8%),choriocarcinoma(7.7%),others(7.7%) however, 51.8% had no histology done. Generally, most of the participants had Suction curettage (69.6%) while the other participants had other treatment options like misoprostol or oxytocin induction ,dilation and curettage while others had spontaneous molar abortion. Prophylactic chemotherapy was given in 33.3% of participants of which 39.3% received Oral chemotherapy (oral methotrexate) while 44.6% received both oral and parenteral chemotherapy(I.V/I.M methotrexate or EMACO). For participants who had Hydatidform mole and were later diagnosed with Choriocarcinoma/GTN, the hydatidform mole had been managed with suction curettage 66.7%