Gestational Trophoblastic Disease in a Resource-Limited Setting: A Prospective Study of Molar Pregnancy at a Teaching...

Background Molar pregnancy is a premalignant form of gestational trophoblastic disease with a higher incidence reported in Asian populations. Data from Northeast India, where geographic and healthcare disparities may influence disease patterns and outcomes, remain limited. Methods This prospective observational study was conducted over 15 months at a tertiary care teaching hospital in Northeast India. Women aged 15-49 years with ultrasonography- and histopathology-confirmed molar pregnancy were included. Clinical and treatment data were recorded, and patients were followed with serial serum β-human chorionic gonadotropin (β-hCG) until normalization. Predictors of chemotherapy requirement were analyzed using logistic regression and ROC curve analysis. Results The mean age was 27.8±5.5 years. Common presenting features included amenorrhoea and vaginal bleeding. Complete mole was the predominant subtype (75.9%). Suction evacuation was performed in 83.3% of patients as primary treatment, while 22.2% needed chemotherapy. On multivariate analysis, β-hCG ≥100,000 mIU/mL (aOR 4.9, p=0.003) and uterine size greater than gestational age (aOR 2.8, p=0.048) were independent predictors of chemotherapy. Receiver operating characteristic (ROC) analysis showed good predictive performance (AUC 0.78). Ultrasonography showed moderate agreement with histopathology (kappa=0.62). Discussion The age and socioeconomic patterns differed from traditional risk profiles, suggesting regional and genetic influences on disease distribution. Management outcomes are favourable, supported by improved imaging facilities, effective treatment, and meticulous surveillance. β-hCG demonstrates good discriminatory ability and may aid early risk stratification. Larger multicentric studies are needed in the future.