The Spectrum of Clinical Presentations of Gestational Trophoblastic Disease from a Tertiary Care Center

ABSTRACT

Introduction: Gestational trophoblastic disease (GTD) is a disease of pregnancy and therefore a disease of women. GTDcomprises the heterogeneous group of related lesions arising from abnormal proliferation of trophoblast of the placenta witha spectrum of disorders ranging from benign to malignant disease. The malignant form of GTD collectively called gestationaltrophoblastic neoplasia (GTN).Aim: The aim of this study was to analyze the clinical characteristics, outcomes, and factors affecting response to treatment.Materials and Methods: We undertook a retrospective review of GTD cases treated at our center from 2017 to 2019, inwhich patients demographic profile and clinical information were identified including age, gravidity, symptoms, gestational age,consanguinity, pathologic diagnosis, investigations, treatment, and follow-up data, and subsequently, statistical analysis was done.Results: During the 3-year period, 78 cases of GTD were reviewed. Complete and partial molar pregnancies were diagnosed in49 (68%) and 29 (32%) cases, respectively. According to the International Federation of Gynecology and Obstetrics anatomicalstaging, the most GTN patients were assessed as Stage I and Stage III, at 80.0% and 11.4%, respectively. Post-molar GTNdeveloped more frequently in women who had a pathologic diagnosis of complete mole, uterus larger than 14-week size, andpretreatment human chorionic gonadotropin levels more than 150,000 mIU/mL. Our study demonstrated a superior responseto single-agent actinomycin D (90%). The overall cure rate at our center approached 96% during the study period.Conclusion: GTD results in significant maternal morbidity, which leads to mortality if not detected early. The patients shouldbe risk stratified for proper management and referred to experienced centers that have capabilities for adequate supportivecare and consequent treatment.