EP403/#1097 Management and outcome of gestational trophoblastic disease in a tunisian public hospital

Objectives

Gestational trophoblastic disease (GTD) arises from abnormal placenta and is composed of a spectrum of premalignant to malignant disorders. The aim of this study was to analyze the current management modalities as well as the outcome of GTD.

Methods

This study was carried out in the gynecology and obstetrics department of Ben Arous hospital over a period of 18 years extending from January 2004 to June 2021. We included all patients matching the FIGO diagnostic criteria or with a histological confirmation.

Results

204 cases of GTD were reported in our study divided as follows: 198 hydatidiform moles and 15 cases of gestational trophoblastic neoplasia (GTN). The mean age of patients was 33.86 years. 81% of molar pregnancies were diagnosed between 6 and 12 weeks’ gestation. In 12.7% of patients, the initial diagnosis was that of an incomplete abortion or a miscarriage. These patients received Misoprostol: 57% of them had a subsequent aspiration for failure to evacuate. 82.3% of patients had an ultrasound-guided uterine evacuation straight away. Contraception was systematic in all patients. Clinical Follow-up, monitoring serum chorionic gonadotropin (βHCG) as well as ultrasounds were performed in 77.5% of the patients only. A positive outcome was observed in 144 patients while 9 patients had an unfavorable evolution defined either by stagnation or by re-ascension of the βHCG. Hysterectomy was performed in 3 cases. 9 patients had chemotherapy.

Conclusions

GTN is a significant source of maternal morbidity with increased risk of mortality from complications if not detected early and treated promptly.