Sujatha, S (2008) A Study of Epidemiological factors and clinical presentations of molar pregnancies in Institute of Obstetrics and Gynaecology. Masters thesis, Madras Medial College, Chennai.
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Abstract
INTRODUCTION:This is a Prospective study of Gestational Trophoblastic Diseases from one of the largest maternity centers of South Asia – Institute of Obstetrics and Gynecology of Madras Medical College, Chennai. This is a tertiary referral center in South India giving tertiary care to the people from the state of Tamilnadu and also the neighbouring states of Andra Pradash and Karnataka. This study was conducted over a period of one year covering Ninety Patients. Gestational trophoblastic neoplasms (GTN) are proliferative as well as degenerative disorders of placental elements and includes complete (or) partial hydatidiform mole (90%), invasive mole 5.8% which could also be metastatic villous (or) avillous choriocarcinoma. (1-2%) and placental site tumor (1-2%), GTD is a discrete pool of epidemiological and clinicopathological entities. Therefore, every geographical region should be studied separately. The Indian subcontinent is under reported for this disease. Hence this analysis comes from one of the largest maternity center of India. In this study we have analyzed the epidemiological factors and clinical presentation of molar pregnancy and compared the changing trends in the clinical presentation. AIM OF THE STUDY: The study aims to analyse the epidemiological factors of molar pregnancy and its varied clinical presentation in the Institute of Obstetrics and Gynaecology, Govt. Hospital for Women and Children, Egmore, Chennai. MATERIALS AND METHODS: The study was conducted in the Department of Medical Oncology and department of Obstetrics and Gynaecology, Government Hospital of Women and Children, Egmore, Chennai. Period of Study: The cases registered in the dept of medical oncology from July 2006 – July 2007 were taken up for analysis / study. Sample Size: The patients who were studied during this period 110 patients. Normal Deliveries during the same period was taken as control group. Methods: This is an observational and a prospective study in patients with vesicular mole. (Symptoms, USG, BHCG level, HPE and Macroscopic specimen appearance). Excluded all cases referred for oncology care to IOG. The patients under the study were admitted in IOG and undergone suction evacuation in this Institute, and its sister Institute KGH, Triplicane. All were registered and followed up in the Department of Medical Oncology IOG, Chennai. This study was conducted over a period of one year in the medical oncology department of IOG. The patients were inter viewed, examined and their medical records were checked thoroughly. All relevant factors such as age, parity gravida socioeconomic status, general condition, age of menarche were noted. Apart from this their previous obstetric history like the previous pregnancy and their outcome and previous history of vesicular mole was also noted. SUMMARY: The incidence of molar pregnancy over past 10 years had definitely come down. The development and improvement of suction curettage, termination of pregnancy, contraceptive techniques, diagnostic imaging, and biochemical testing have been associated not only with a fall in the birth rates, but also with a reduction in the incidence of trophoblastic disease. • Delayed referral and improper follow up of patients may lead to complications. Hence the need to educate the patients on the risk factors, early signs and symptoms, the need for prompt referral and proper follow up. This will not only bring down the mortality but also the morbidity of GTD. • In considering the clinical presentation, 12% of the patients were asymptomatic diagnosed during their routine Antenatal USG. These patients had good prognosis. So with the current widespread use of Ist trimester USG, can detect abnormal pregnancy like molar pregnancy earlier. • The risk of molar pregnancy is more in teenage pregnancy and in old age pregnancy. This can be prevented by improving the female. • literacy and adolescent health education. Permanent sterilization after completion of family will bring down the old age pregnancy. • Blood grouping did not throw any light about the risk of GTD. • Patients with uterine size larger than the period of Amenorrhoea had higher βHCG levels and increased incidence of PTD. By educating the health care providers, and patients about early signs and symptoms, of GTD like hyperemesis, first trimester spotting, early onset PIH, will help in early referral to higher centers. • The need for tertiary care for all patients with molar pregnancy will bring down the morbidity of this disease. • Careful and reliable Human Chorionic Gonadotrophin monitoring is essential for the early detection of post molar persistent trophoblastic tumor. • If PTD diagnosed during follow up and treated earlier, the low risk trophoblastic disease are 100% curable. • Gestational trophoblastic tumors have an excellent prognosis if diagnosed and treated in time, and the potential for child bearing can be maintained CONCLUSION: Early pregnancy USG will help in early recognition of abnormal pregnancy like molar pregnancy, this will definitely reduce the morbidity of this curable disease. • Proper follow up helped in recognizing the cases of persistent trophoblastic disease early. • If Persistent Trophoblastic Disease diagnosed during follow up and treated earlier, the low risk trophoblastic diseases are 100% curable.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | epidemiological factors ; clinical presentations ; molar pregnancies ; Institute of Obstetrics and Gynaecology. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Nov 2017 03:40 |
| Last Modified: | 09 Dec 2017 05:09 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4135 |
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