Molar pregnancy: a 15-year experience in a single tertiary institution

Abstract

Background: Gestational trophoblastic disease (GTD) is a group of uncommon conditions associated with pregnancy that arise from abnormal trophoblastic tissue following abnormal fertilisation. There is minimal data from African countries. We studied the management outcomes of hydatidiform mole (HM) at a single tertiary institution in South Africa.

Methods: This was a retrospective descriptive study of HM from January 2004 to December 2019. We included all women with a confirmed histological diagnosis.

Results: There were 554 057 deliveries and 235 molar pregnancy cases, with an incidence of 0.42/1 000 deliveries. Suction evacuation was performed in 97.4% of patients. Patients between 20 and 40 years constituted 78.7% of cases, with most patients (51.3%) diagnosed in the second trimester. The most common presenting complaint was vaginal bleeding (37.4%). The most common complication was hyperthyroidism (16.6%). A blood transfusion was required by 26 patients (11.2%). Due to ongoing bleeding, 17 patients (7.2%) required a second evacuation, with four patients (1.7%) requiring a hysterectomy due to excessive haemorrhage. Patients with molar pregnancy normalised their human chorionic gonadotropin (hCG) at 12 weeks post-evacuation. There were 42 cases of persistent trophoblastic disease (PTD), expressing hCG levels above 6 000 mIU/ml and 4 000 mIU/ml at four and eight weeks, respectively. Almost 45% of patients never completed follow-up.

Conclusion: The incidence of GTD at our centre is declining but remains an important cause of morbidity. We recommend a revised follow-up protocol for patients with complex socio-economic backgrounds, as the current protocol is associated with an increased rate of follow-up loss.