Clinical Characteristics and Outcomes of Management of Clinically Diagnosed Hydatidiform Mole at Knh

Abstract

Background: Gestational Trophoblastic Disease (GTD) refers to a spectrum of interrelated but histologically distinct tumours originating from the placenta. They include Hydatidiform Mole (partial or complete), invasive mole, Placental Site Trophoblastic tumour (PSTT) and choriocarcinoma. Hydatidiform mole (also known as Molar pregnancy) is a form of GTD in which an abnormal pregnancy develops, characterised by varying degrees of trophoblastic proliferation, with vesicular swelling of placental villi, associated with an absent or an abnormal fetus/embryo. It is considered a benign form of GTD but with malignant potential. Molar pregnancy contributes directly to maternal morbidity, as well as to morbidity due to its medical complications and Gestational Trophoblastic Neoplasia (GTN). Objective: To determine the clinical characteristics and outcomes of management of clinically diagnosed hydatidiform mole at Kenyatta National Hospital over 5 years (2013 to 2017). Methodology: The study adopted adescriptive retrospectivestudy design, where records for 137 patients (who were admitted between January 2013 and December 2017) with a clinical diagnosis of Hydatidiform mole were identified. Data was retrieved and analysis of how they presented and were managed was done. Results: 42 (30%, n=137) of the patients admitted as molar pregnancy were aged between 25-29 years, 6 (4%) less then 20 years and 9 (7%) more than 40 years. The mean gestation age at presentation was 17 weeks (SD 7.4). Per vaginal bleeding was the most common symptom (105, 77%). 48 patients (52.2%) had blood group O

and 46 patients (34%) had documented histologic confirmation of molar pregnancy. None of the patients was followed up at Kenyatta National Hospital for six completed months. Conclusion: The clinical presentation of molar pregnancy is relatively uniform in different set-ups, but the approach to definitive diagnosis of molar pregnancy at Kenyatta National Hospitaland their management and follow-up there after is suboptimal and inadequately documented hence outcome of management cannot be objectively determined.