Prevalence, Management, and Outcomes of Patients Diagnosed with Molar Pregnancy at the Georgetown Public Hospital Corporation (GPHC) between 2018 to 2022.

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Bibi Nafeeza Parjohn, Ravindra Hardyal, Shivani Samlall

Abstract

Background


Hydatidiform mole, also known as molar pregnancy, is a type of gestational trophoblastic disease (GTD) caused by abnormal trophoblast cell growth inside the uterus after conception. This disease is rare and can lead to the development of a tumor in the uterus from tissue formed after conception. Treatment involves surgical removal of the molar pregnancy and monitoring of human chorionic gonadotropin levels to confirm the resolution of the disease or detect the development of gestational trophoblastic neoplasia, which is the malignant form of the disease. To ensure proper care and recovery, early diagnosis and treatment followed by reliable contraception use is recommended by international health organizations such as FIGO and NCCN.


Objectives:


 To estimate the prevalence of Molar pregnancy at the GPHC.


To identify the clinical presentation of patients diagnosed with molar pregnancy at the GPHC.


To identify the management and follow-up of patients with molar pregnancy at the GPHC.


To evaluate the outcomes of patients managed for molar pregnancy at the GPHC.


Methods:


A retrospective cohort study of all patients diagnosed with molar pregnancy from 1st January 2018 to 31st December 2022, evaluating the prevalence, clinical presentation, management, and follow-up of patients diagnosed with molar pregnancy. All patients who were admitted to the gynecology ward with an ultrasound diagnosis of molar pregnancy and patients who presented at the Gynecology-outpatient department with a histopathological diagnosis of molar pregnancy during the study period were included in the study.


Results:


At GPHC, the prevalence of molar pregnancy is 0.85 per 1,000 live births. Of all the patients, 68% experienced bleeding per vagina, while 32% had incidental findings on ultrasound. All the patients underwent a dilation and suction evacuation procedure. 72% of patients did not follow up after their discharge. Among the patients who were treated for molar pregnancy, 36% opted for the barrier method of contraception, 28% used the sub-dermal implant, 12% chose Depo-Provera, 8% underwent bilateral tubal ligation, 8% used combined oral contraceptive, 4% selected the IUCD, and 4% went for the withdrawal method.


29% of the patients had complete molar pregnancies, 8% had partial moles, and 59% of the histopathology findings were unknown.


Recommendations:


Development of a national registry for all Molar pregnancies and a standardized protocol for management of Molar pregnancy.


Conduct histopathology for all patients who have undergone uterine evacuation for missed or incomplete abortion.


Beta hCG testing should be made available consistently or sub-contract the test if not available to minimize the cost to patients, ensuring follow-up

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