Gestational Trophoblastic Disease and Gestational Trophoblastic Neoplasm - An Experience at Tertiary Care Hospital

Objective: To determine the frequency of gestational trophoblastic diseases and gestational  tropho-  blastic neoplasm, its risk factors and prognosis. Methods: This was a descriptive,  cross-sectional  study  conducted  at  Civil  Hospital,  Karachi  from  March 2015 to September 2015. All cases of gestational trophoblastic disease after necessary inves- tigations like tumour marker b-hCG, ultrasound with classical picture of "bunch  of  grapes"  or  "snow  storm" pattern and X-ray chest (for lung metastases) under went suction evacuation.  In  all  cases  specimen was sent for histopathology to confirm gestational trophoblastic disease. After primary treat- ment, cases were followed with  b-hCG till complete remission was achieved. During follow-up, cases     were labelled as gestational trophoblastic neoplasm on the basis of International Federation of Gyne-  cology and Obstetrics (FIGO) criteria. After risk scoring on World Health Organization (WHO) criteria, chemotherapy was given. Results: Out of 497 pregnant ladies, 40 were cases of gestational trophoblastic disease (8.05%). Frequency/obstetric case was 1.7% and frequency/delivery was  2.1%.  Out  of  40  cases  13  (32.5%)  were cases of gestational trophoblastic neoplasm. Out of 13 cases  of  gestational  trophoblastic  neo-  plasm 9 (69.23%) were labelled as low-risk and 4 (30.76%) as high-risk cases. All cases  achieved  complete remission. One case of high-risk group expired. Conclusion: All women with gestational trophoblastic disease must  be  followed  as  per  recommenda- tion with serum b human chorionic gonadotropin  measurement  until  the  levels  are  undetectable,  for early diagnosis and optimum treatment of gestational trophoblastic neoplasm.