‘’A profile of cases of Gestational Trophoblastic Neoplasia at a large tertiary centre in Dubai”

1. OPTIONALLOGO HERE ‘’A profile of cases of Gestational Trophoblastic Neoplasia at a large tertiary centre in Dubai” Authors : Tasneem Husaini Rangwala MD , MRCOG, Faiza Mahgoub Badawi FRCOG. Department of Obstetrics and Gynaecology, Latifa (Al Wasl )Hospital, Dubai, UAE. OPTIONALLOGO HERE Methods Results Objectives Conclusions Introduction 35 cases of GTD were seen in 2 years with 7000 deliveries / year, giving a prevalence of 1 / 400 live births. Age range: 17 – 49 yrs . Peak in 21 to 30 years age group. . Parity range- 0 to 10 . majority in the parity group 1 to 4. 60% -local Arab nationals while 40% - expatriates • 35 cases of molar pregnancies were managed at AWH during 2 yr period from Jan. 2007 to Dec. 2008 • Incidence: 1/400 • 97.5% of cases had baseline β-HCG levels and initial ultrasound scan . • 60% were cured by suction curettage alone,11% by second evacuation , 22.8% needed chemotherapy . • Default rate : 8.5 % • Complications were minor and seen in 11% cases. • Follow up was regular in 85.7% cases • Duration of follow up - <6 mths. in 37.1 % cases • There were 37% cases of complete mole and 48.5% cases of partial mole . No cases of invasive mole, choriocarcinoma or PSTT were seen in the study period. • 1/12 cases that received cervical priming went on to have chemotherapy. • GTD is rare but important pregnancy related disorder with an incidence of 1 in 400 in Asia and Latin America. • It is a spectrum varying from benign Hydatidiform mole (complete, partial mole) to malignant conditions. ( invasive mole, choriocarcinoma and Placental Site Trophoblastic Tumour) . • Majority of cases can be cured by simple surgical intervention. • Those cases requiring chemotherapy are generally cured with very low toxicity treatment. • Unlike other Gyn. malignancies fertility can be preserved and normal pregnancy outcome anticipated • Retrospective data collected for 2 years (from Jan. 2007- Dec. 2008) for women admitted with suspected diagnosis of molar pregnancy at AWH. • The data from 35 files were reviewed to extract information. • Descriptive statistics used. • Cases were managed according to institutional protocol based on RCOG (Royal college of obstetricians and gynaecologists) guidelines Previous pregnancy Recommendations 1. There should be a regional / national registry for GTD where all these cases are registered and receive appropriate follow up. 2. All cases should have a baseline β- HCG level and pelvic ultrasound before any intervention. 3. Caution during uterine evacuation can avoid serious complications. 4. Cervical preparation with prostaglandin should be done in selected cases and prolonged preparation should be avoided. 5. Repeat evacuation in selected cases avoids need for chemotherapy. Data Collection Tool Facts And Figures From AWH January 2007 – December 2008 6. All cases of persistent GTD should have FIGO risk scoring and receive chemotherapy in specialised centres. 7. Follow up is ideal for one year but cases should be counselled for contraception and refrain from pregnancy for at least 6 months Objectives were To study: (1)the prevalence of different types of gestational trophoblastic neoplasia (GTN) in the local and non local population of women at Latifa (Alwasl) hospital , a tertiary level referral centre for northern Emirates. (2)the safety of cervical preparation before uterine evacuation. (3)the role of repeat uterine evacuation in curing these cases. 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