Host and risk factors for gestational trophoblastic disease: a hospital-based analysis from India

Gestational trophoblastic disease (GTD) adversely affects pregnancy by the development of Hydatidiform mole and placental site gestational tumor. 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. This paper analyses the data from a large hospital.

92 patients with GTD were analyzed in the period from 1995 to 1999.

The incidence of GTD was 1.31 per 1000 live births and one per 967 pregnancies irrespective of outcome. 93.5% of the patients had moderate to severe vaginal bleeding as presenting symptom, while routine antenatal ultrasonography revealed GTD in 6.5% completely asymptomatic patients. Among the major risk factors were age over 30 (p=6.3 x 10(-3), RR=2.7), previous abortion (p<0.001, RR=3.9) and multigravida (p=4.9 x 10(-6), RR=4.1). Early detection and treatment on established lines can achieve 95.7% complete response and 6.5% partial response. 17 out of 21 invasive moles (80.9%) were found with multiple abortions and mechanical interference in form of check curettage, which probably implicates repeated mechanical interference in the conversion of a mole into an invasive one.

The present study explores the status of established host-related risk and prognostic factors in the Indian context. In cases of invasive mole, the role of repeated mechanical interference in the form of check curettage needs further evaluation.