Gestational trophoblastic disease in a tertiary hospital in Nnewi, southeast Nigeria

Abstract

Objective: This study was conducted to evaluate the prevalence of GTD and describe its clinical features and management in a tertiary level hospital in Nnewi Southeast Nigeria. Methods: We studied retrospectively the cases of GTD that were proved histologically and managed in the department of Obstetrics and Gynaecology of Nnamdi Azikiwe University Teaching Hospital Nnewi over a 5years period (200 - 2008).                                                        Results: The frequency of GTD in Nnewi is 4.6 per 100 deliveries. Ten (66.7%) of the cases were choriocarcinoma while 5 (33.3%) were hydatidiform mole. There was no case of invasive mole or placental site trophoblastic tumour (PSTT). The age range of the patients was 15 - 46 years with a mean of 31+ 8.6 years. There was no significant association between age and GTD (X2 = 4.5; p = 0.609) and between Parity and GTD (x2 = 1.87; p = 0.171 ). Most of the patients (73.3%) presented in late second trimester and the commonest mode of presentation was abnormal vaginal bleeding. The symphysio - fundal height was more than the estimated gestational age in 9 (60%) of cases. All the patients made an earlier presentation in different peripheral hospitals and were managed as incomplete miscarriage prior to presentation in our hospital. The average duration of follow - up in these patients was 2.4 =3.2 weeks. Contraception use was documented in 3 (20%) of the patients. Conclusion: There was a high prevalence of GTD and notably choriocarcinoma. The associated mortality was high. There was lack of suspicion of the pathology among the primary healthcare providers. This study suggests that all cases of evacuation products should be subjected to histopathological examination. There is the need to emphasize the role of adequate and appropriate counselling in the management of the patients with GTD. Call and recall system should be introduced in the management of patients with GTD to improve their compliance to recommended management standard. This will improve the prognosis of the condition in our women.                                                             Niger Med J. Vol. 50, No. 4, Oct. - Dec., 2009: 87–89 Key words: gestational trophoblastic disease, tertiary hospital Southeast Nigeria.