اسم المؤلف:
حنان جواد كاظم
اسم المشرف:
رغد عبد الحليم
المستخلص:
Gestational trophoblastic diseases (GTD) are important and interesting part of gynecological oncology. Women diagnosed with GTD should be counseled that about 8% become malignant and GTN is a significant cause of morbidity, loss of fertility and, rarely, mortality in young women. All form of GTD produce B - hCG and monitoring this hormone is an accurate biomarker for screening, diagnosis, therapeutic response and follow up.(1) Objectives : To analyze and determine the types, complications, management and outcomes of gestational trophoblastic disease (GTD) and those with irregular follow - up in Baghdad Teaching Hospital through an observational descriptive based approach.Study design : Observational descriptive study Setting : Department of Obstetrics and Gynecology, Baghdad Teaching Hospital - Medical City, Baghdad, Iraq. Patients and methods : During the period from January 2013 to January 2014, (60) patients admitted to our hospital were diagnosed and registered to have GTD on the basis of histopathological report, were included in this study. During this period, analysis of patients′ data was done regarding their age, residence, parity, blood group, type of molar pregnancy, 1st clinical presentation, percentage of patients who developed persistent GTD and needed further management with chemotherapy and follow up, their outcome (remission, complications, lost to follow up), history of prior molar pregnancy, then complete medical and gynecological examination was done for each case. All patients were followed up by serial B - hCG titer according to WHO protocol except those who were lost to follow up. Each patient has a hand book in which her complete information about her condition is documented.Results : Thirty six patients out of 60 (60%) developed persistent gestational trophoblastic disease received chemotherapy, 20 patients (55.5%) out of those 36 patients required only single - agent chemotherapy (methotrexate). 12 patients (33.3%) required single then shifted to multi - agent chemotherapy while only 4 patients (11.1%) were required multi - agent chemotherapy since diagnosis, all 36 patients got complete remission after having their risk scoring system. Six cases (10%) got spontaneous remission following evacuation, while 18 patients (30%) had irregular or lost to follow up and presented later on with different presentation, One patient present with heavy vaginal bleeding and on examination and investigation cervical growth was diagnosed then hysterectomy was done followed by chemotherapy and got remission. Three patients presented with metastasis, one to the liver, another to the lung and both of them received multi - agent chemotherapy at oncology unite and got remission. Another one presented with advanced stage pulmonary metastasis and she unfortunately died due to adult respiratory distress syndrome and respiratory failure. Another patient presented many months later with heavy vaginal bleeding and large uterine size, also she died soon after admission. The results were established from the obtained data and then comparison was donewith other studies, two cases out of 18 died due to their neglection to our medical appropriate management and irregular follow up and presented later with advanced stage.Conclusion : The high proportion of GTD was in age group 15 - 25 years old, rural area, multiparity, blood group O, house wives. Complete molar pregnancy was the most common type of GTD in our study. Most of patients with irregular follow up are multiparous, from rural area, blood group A and below 18 years old.Chemotherapy is effective in treatment of persistent GTD. The management of gestational trophoblast disease in our hospital not differs from that protocol found in other centers in the world, However, Follow up of patients is the real problem for both patients and doctors because no special centers for GTD and no registration to a patients in proper way and poor knowledge and education of our population regarding this disease.
