Gestational trophoblastic disease managed at Grey's Tertiary Hospital : a five-year descriptive study

Abstract

BACKGROUND: A study was undertaken to describe the outcomes of gestational trophoblastic disease (GTD) and to determine the influence of antecedent pregnancy, the distance travelled by patients to Grey’s Hospital (GH), and HIV status on the disease and clinical outcomes. METHODS: The files of all patients admitted to GH with a diagnosis of GTD from January 2013 to December 2017 were retrospectively reviewed. RESULTS: Sixty-three files were analysed. Thirty-six (57.1%) patients travelled < 80.5 km and 27 (42.9%) travelled ≥ 80.5km to GH. Eighteen (29%) patients were HIV positive with CD4 count ≥ 200 cells/mm3 . Twenty-six (41.3%) patients had antecedent term pregnancies, 12 (19.1%) and 11 (17.5%) had antecedent hydatidiform molar pregnancy (HMP) and spontaneous miscarriage respectively. Fifty (79.4%) patients presented with vaginal bleeding. Thirty (47.6%) patients were diagnosed with molar pregnancy and 33 (52.4%) patients had gestational trophoblastic neoplasia (GTN). Fourteen (42.4%) patients received singledrug chemotherapy while 19 (57.6%) received multidrug chemotherapy with a remission rate of 90.9%. The final outcome of the study patients was 41 (65.1%) alive without disease, 2 (3.2%) alive with disease, 3 (4.8%) who died and 17 (27%) lost to follow-up. Antecedent term pregnancy was associated with delayed diagnosis, while HMP was associated with early diagnosis of GTN. Long distance travelled by patients was associated with statistically significant levels of poor compliance and final outcomes. HIV-positive status was associated with higher FIGO staging. CONCLUSIONS: The study showed that antecedent pregnancy, HIV status and distance travelled by the patients have an influence on the diagnosis, staging and treatment outcomes of GTN respectively. However, more prospective research is needed to further substantiate these findings.