7- hesham sait - gtd final new

Hesham Sait 6th Medical student ,Faculty of medicine

King Abdulaziz University Hospital

Disclosure

I have nothing to disclose.

Gestational Trophoblastic Disease(GTD)

It is an abnormal condition of the ovum where there are partly degeneration and partly hyperplastic changes in the young chorionic villi, these result in the formation of small cysts of varying size.

Gestational Trophoblastic Disease (GTD)

Pre-Malignant

Complete Mole

Partial Mole

Malignant

Invasive mole

Choriocarcinoma

Placental site trophoblastic tumorsSeckl et al Lancet 2000 and palmeiri et al Lancet 2005

Worldwide incidence of molar pregnancy

Regions Incidence/1000 pregnancies

North America and Europe 0.5–1

Asia and Middle East 1–12

Saudi Arabia 0.94–2.2

South Africa 0.87–4.88

West Africa and Nigeria 1.26

∗ To estimate the prevalence of (GTD) in the western region of Saudi Arabia.

∗ To evaluate the success of treatment and the effect of age and risk group on survival.

∗ Retrospective Coherent study.

∗ All patients treated for GTD between January 2001and December 2010 were identified using KAUH data base.

∗ Medical record was reviewed for age, parity, clinical presentation and treatment outcome.

∗ Data entered in SPSS v20.

∗ Survival of patients with GTN were calculated using Kaplain Mayer Test and Cox Regression were used for independent variable.

∗ Patients with persistent disease were evaluated according to their clinical treatment outcomes.

∗ Ethical approval were obtained.

Results

Demographic data of patients (n = 122)Variable n

Age (years)Mean ± SD (range) 31.52 ± 10.8 (15–56)

ParityMedian (range) 3 (0–7)

Gestational age (weeks)Mean ± SD (Range) 12.42 ± 3.2 (4–22)

Pre-evacuation level of hCG<100,000 u/ml>100,000 u/ml

30 (25%)92 (75%)

Median follow-up(months)Range

2412–72

Number %

SuctionEvacuatio

n71 92.2

Hysterectomy

6 7.8

Summary of patients who underwent hysterectomy as initial

treatment Case

Age (years)

Parity (n) Pathology

1 52 10 Complete mole






Persistent GTD %

Partialmole

1 1.3

Complete mole

19 24.6

All 20 25.9

Criteria used to diagnosed GTN

Plateauing of HCG level over at least three weeks.A 10% or greater rise in HCG for three or more values over at least two weeks.Persistent of HCG six months after molar evacuation.

All had two more cycles after zero HCG

All had one more cycle after zero HCG

1st case: High risk GTN died 24 hours after admission to ICU because of respiratory failure.

2nd case: low risk died from RTA few years after initial treatment of Mtx.

3rd case: low risk died from chemotherapy toxicity thought to be high risk was treated with MAC.

Kaplain Mayer Test Comparison Wilcoxon Test P=0.69 (N/S)

Over-all 5 year survival98%

P=0.49

∗ We report the first survival data for GTN in Saudi Arabia. However, the overall incidence of GTD in Saudi Arabia will be better defined by establishment of a GTD registry.

Acknowledgment

• Prof. Khalid Sait• Dr. Nisren Anfnan• Prof. Basem Aldeek

Thank You..

Education

7- hesham sait - gtd final new