Characteristics, Management, and Outcome of Gestational Trophoblastic Disease in Jimma Universty Medical Center: Retrospective Cross-Sectional Study

Abstract

Background: Gestational trophoblastic disease (GTD) is a spectrum of cellular proliferations arising from the placental trophoblast after normal or abnormal fertilization. GTD are either non neoplastic hydatidiform moles (complete and partial) or true gestational trophoblastic neoplasm (GTN) that have the potential for local invasion and metastasis. Although GTDs primarily affect the reproductive age group, with significant effects on maternal fertility and psychology, the overall work done in our setup to halt GTDs is unsatisfactory and post treatment surveillance is dramatically poor. Several studies have been done on GTD in worldwide, but no articles have been published in or near southwest Ethiopia after gynecologic oncology unit establishment. Objective: The objective of this study to determine of the magnitude and treatment outcome of patients with gestational trophoblastic disease Method: A cross-sectional study was conducted on women diagnosed with gestational trophoblastic disease at JUMC from July, 2021 to August 2024. Data was collected from the patient's chart using a structured questionnaire/checklist, then entered and cleaned using Epi-info version 7.0, and analyzed with SPSS version 26 software. Data was analyzed using univariate and multivariate logistic analysis and odds ratio with confidence interval of 95% (P value 0.05) was determined form patient outcome. Result: A total of 245 GTD patients were studied. The magnitude of GTD was 15.3/1000 deliveries in JUMC during the study period. The Diagnosis of GTN was made in 104 (42.45.4%) of the cases and the most common risk factor for development of GTD was age(most patients were with age group) ≥35 (45.7%). About 206 (84.08%) had vaginal bleeding upon presentation. Hydatidiform mole 58 (23.87%) was commonest histopathologically diagnosed GTD, followed by invasive mole 14 (5.76%) and choriocarcinoma 8 (3.29%). Suction and curettage was the most performed procedure for 107 (73.90%) of molar pregnancy while hysterectomy was done for 67 (28.88%) of GTD patients. 2 GTD patients died associated with suction and curettage and about 10.87% (10) GTN patients were dead. FIGO stages III or IV were about 3.5 (95%CI: 1.03 11.9) times more likely to die than women who had been diagnosed with FIGO stages I or II. One quarter of GTD patients had no surveillance with serum β hCG 59 (24.08%). VIII Conclusion: The study found that GTD was prevalent in JUMC with 15.3/1000 deliveries. Age >35years and prior GTD were most common clinical risk factors for GTD development. Hyperthyroidism (36.32%), preeclampsia (11.84%) and anemia (40.4%) were the most common medical comorbidity found owning to the late presentation. Most patients had no post-molar surveillance until remission, which hampered the eventual illness outcome. Patients with advanced FIGO stage and WHO high-risk were more likely to die; hence early diagnosis and management may improve the overall treatment outcome.