Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

Objectives: To study the clinical presentation and treatment outcome of molar pregnancy at a Tertiary Care Hospital in Dammam, Saudi Arabia. Materials and Methods: Reviewed medical records of all molar pregnancy cases among all the deliveries at a tertiary care hospital in Dammam from 2005 to 2014, after approval by institutional ethical review committee. Data abstracted included patient′s age, parity, presenting symptoms, gestational age at diagnosis, uterine size, ultrasonographic findings, BhCG level at the time of diagnosis and at follow-up after evacuation, and blood loss during evacuation. Data was entered and analyzed using Excel; frequency distribution for categorical variables and descriptive statistics for continuous variables were computed. Results: Of a total of 25,000 deliveries in ten years, 22 cases of complete molar pregnancy were encountered: 0.9 cases of molar pregnancy per 1000 pregnancies. Majority of patients (63.7%) were older than 35 years, and were nulliparous (45.5%). The commonest symptom was vaginal bleeding (86.4%) followed by hyperemesis gravidarum (41.0%); Hyperthyroidism was seen in 1 patient (4.5%). Ovarian enlargement by theca-lutin cyst was seen in 3 patients (13.6%). The majority of patients (63.6%) had normal BhCG within 9 weeks (63 days) after suction curettage. The majority of the cases followed a benign course. Conclusion: Aged older than 35 years seems a risk factor and vaginal bleeding is the commonest presenting symptom. Early booking of pregnant women to antenatal care clinics and routine first trimester ultrasound made diagnosis easier and earlier before complications appear.

[1]  Li'na Hu,et al.  Prophylactic chemotherapy for hydatidiform mole to prevent gestational trophoblastic neoplasia. , 2017, The Cochrane database of systematic reviews.

[2]  R. Berkowitz,et al.  Molar Pregnancy and Gestational Trophoblastic Neoplasia , 2017 .

[3]  M. Seckl,et al.  Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following complete hydatidiform mole: a historical database review , 2016, BJOG : an international journal of obstetrics and gynaecology.

[4]  R. Berkowitz,et al.  The effect of adolescence and advanced maternal age on the incidence of complete and partial molar pregnancy. , 2016, Gynecologic oncology.

[5]  N. Sebire,et al.  Risk of recurrent molar pregnancies following complete and partial hydatidiform moles. , 2015, Human reproduction.

[6]  F. Sweep,et al.  Trends in incidence for gestational trophoblastic disease over the last 20 years in a population-based study. , 2016, Gynecologic oncology.

[7]  T. Colgan,et al.  Placental Molar Disease: What are the Benefits and Barriers to the Adoption of a Comprehensive Diagnostic Service? , 2015, International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists.

[8]  M. Bakhtiyari,et al.  Postmolar gestational trophoblastic neoplasia: beyond the traditional risk factors. , 2015, Fertility and sterility.

[9]  R. Berkowitz,et al.  Changing presentation of complete hydatidiform mole at the New England Trophoblastic Disease Center over the past three decades: does early diagnosis alter risk for gestational trophoblastic neoplasia? , 2015, Gynecologic oncology.

[10]  N. Sebire,et al.  Histopathological and immunohistochemical features of early hydatidiform mole in relation to subsequent development of persistent gestational trophoblastic disease. , 2014, The Journal of reproductive medicine.

[11]  L. Marions,et al.  Current clinical features of complete and partial hydatidiform mole in Sweden. , 2014, The Journal of reproductive medicine.

[12]  M. Seckl,et al.  The relationship of maternal age to molar pregnancy incidence, risks for chemotherapy and subsequent pregnancy outcome , 2013, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[13]  M. Vasei,et al.  Outcome of Subsequent Pregnancies in Familial Molar Pregnancy , 2013, International journal of fertility & sterility.

[14]  K. Curtis,et al.  Combined oral contraceptive and intrauterine device use among women with gestational trophoblastic disease. , 2009, Contraception.

[15]  R. Barakat Principles and Practice of Gynecologic Oncology , 2009 .

[16]  Gynecologists ACOG Practice Bulletin #53. Diagnosis and treatment of gestational trophoblastic disease. , 2004, Obstetrics and gynecology.

[17]  R. Waterland,et al.  Early nutrition, epigenetic changes at transposons and imprinted genes, and enhanced susceptibility to adult chronic diseases. , 2004, Nutrition.

[18]  T. Khashoggi Prevalence of gestational trophoblastic disease. A single institution experience. , 2003, Saudi medical journal.

[19]  N. Sebire,et al.  Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy , 2003, BJOG : an international journal of obstetrics and gynaecology.

[20]  R. Coleman,et al.  Gestational trophoblastic disease: a study of mode of evacuation and subsequent need for treatment with chemotherapy. , 2000, Gynecologic oncology.

[21]  F. Flam,et al.  The diagnosis of molar pregnancy by sonography and gross morphology , 1999, Acta obstetricia et gynecologica Scandinavica.

[22]  Kim Jh,et al.  Changes in gestational trophoblastic tumors over four decades. A Korean experience. , 1998 .

[23]  R. Berkowitz,et al.  Complete molar pregnancy. Clinical trends at King Fahad Hospital, Riyadh, Kingdom of Saudi Arabia. , 1998, The Journal of reproductive medicine.

[24]  J. H. Kim,et al.  Changes in gestational trophoblastic tumors over four decades. A Korean experience. , 1998, The Journal of reproductive medicine.

[25]  R. Berkowitz,et al.  The Changing Clinical Presentation of Complete Molar Pregnancy , 1995, Obstetrics and gynecology.

[26]  S. Chattopadhyay,et al.  Epidemiologic study of gestational trophoblastic diseases in Saudi Arabia. , 1988, Surgery, gynecology & obstetrics.