DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20151280

Gestational trophoblastic disease findings of a five year period retrospective audit

Balvinder Sagoo, Nashwa Abulhassan

Abstract


Background: To identify the incidence, characteristics and symptoms of women diagnosed with gestational trophoblastic disease (GTD) in an early pregnancy unit in Slough, Uk. To assess the accuracy of ultrasound diagnosis in detecting GTD in our early pregnancy unit at Wexham Park Hospital. To evaluate the management of patients diagnosed with GTD compared to RCOG guidelines.

Methods: Qualitative observational study, retrospective audit over a five year period. Frimley Health NHS Foundation Trust January 2010 – December 2014. Women diagnosed with GTD based on ultrasound or histological diagnosis. Patients diagnosed with GTD/ GTN were identified through registration with Charing Cross Hospital (CXH), screening centre for GTD. Data was collected from CXH, WPH information databases: CRIS, PACs and ICE. Data was analysed and results presented.

Results: Over a 5 year period, 53 out of 21,995 pregnant patients were diagnosed with GTD (Incidence of 1 in 415)

62% of patients diagnosed with GTD were of white ethnic origin. Accuracy of ultrasound diagnosis in our unit was 40%.

Conclusions: We found a high incidence of GTD in the non-Asian population (1 in 415). Most patients who had been diagnosed with GTD on ultrasound were in the first trimester. Accuracy of ultrasound diagnosis is 40 % over a 5 year audit period. The main ultrasound findings of GTD were cystic changes and mixed echogenic echoes. Patients who were undiagnosed on ultrasound but had histological diagnosis of GTD had missed miscarriage as the predominant ultrasound diagnosis. Most patients were registered with the screening centre within six weeks of the histological diagnosis.

Keywords


Gestational trophoblastic disease, Ultrasound diagnosis, Characteristics, Symptoms

Full Text:

PDF

References


Tham BWL, Everard JE, Tidy JA, Drew D, Hancock BW. Gestational trophoblastic disease in the Asian population of Northern England and North Wales. BJOG. 2003;110:555–9.

Sebire NJ, Fisher RA, Foskett M, Rees H, Seckl MJ, Newlands ES. Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy. BJOG. 2003;110:22–6.

RCOG Green-top guideline, N0 38. 2010, Management of gestational trophoblastic disease.

RCOG Green-top guideline, 2011, Management of gestational trophoblastic disease.

Altieri A, Franceschi S, Ferlay J, Smith J. Epidemiology and aetiology of gestational trophoblastic diseases. The Lancet Oncology. 2003;4:670-8.

Tham BWL, Everard JE, Tidy JA, Drew D, Hancock BW. Gestational trophoblastic disease in the Asian population of Northern England and North Wales. BJOG. 2003;110:555–9.

Lybol C, Thomas C, Bulten J, Dijck J, Sweep F, Massuger L. Increase in the incidence of gestational trophoblastic disease in the Neatherlands. Gynecology Oncology. 2011;121:334-8.

Bates M, Everad J, Wall L, Horsman JM, Hancock B.W. Is there a relationship between treatment for infertility and gestational trophoblastic disease? Human Reproduction. 2004;19:365-7.

Kenny L, Seckl M. Treatments for Gestational Trophoblastic Disease. Expert Review of Obstetrics & Gynecology. 2010;5(2):215-25.

Parazzini F, LaVecchia C, and Pampallona S. Parental age and risk of complete and partial hydatidiform mole. Br J Obstet Gynecol. 1986;93:582–5.

Mangili G, Garavaglia E, Cavoretto P, Gentile C, Scarfone G, Rabaiotti E. Clinical presentation of hydatidiform mole in northern Italy: has it changed in the last 20 years? Am J Obstet Gynecol. 2008;198(3):302.

Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol. 1995;86(5):775-9.

Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Routine pre-evacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center. Ultrasound Obstet Gynecol. 2006;27:56–60.

Al-Mulhim A. Hydatidiform Mole: a study of 90 cases. J Family community Med. 2000;7(3):57–61.