Risk factors associated with molar pregnancy
Background: Gestational Trophoblastic Diseases (GTD) is one of the causes of morbidity and mortality among women in the reproductive age group.
Methodology: It was a cross sectional study done in the Obstetrics & Gynaecology department of Shaheed Suhrawardy Medical College & Hospital, Dhaka, between July 2015 to December 2015 to determine the risk factors associated with molar pregnancy. Thirty three consecutive patients who were diagnosed as molar pregnancy were selected as the study population. Diagnosis was done by examination, serum β-hCG assay & ultrasonographic findings. Histopathological examination of uterine contents was done in all the cases. Data was collected by face-to-face interview by using a pre-design questionnaire. Variables like age, parity, socio economic condition, Blood group, Obstetric history & previous history of molar pregnancy. Ultrasonography & Serum β-hCG assay was the main diagnostic tool in this study. Other variables like mode of treatment, complications, follow-up and outcome of the patients were also recorded.
Majority 16 (48.5%) of the patients were belonged to 21 – 35 years age group with range from 18 to 47 years. Primi gravida were 10 (30.3%), 18 (54.5%) were multigravida and 5 (15.2%) were grand multipara. Most of the (84.8%) patients came from below average income group family and only 5 (15.2%) patients came from average income group family. Regarding the risk factors more than a half 17 (51.5%) of the patients belonged to more than 35 years and under 21 years. Two (6.12%) had previous history of molar pregnancy, 4 (12.1%) had previous history of spontaneous abortion and 3 (9.1%) used long term oral contraceptive. For diagnosis serial serum β-hCG was done in 28 (84.8%) patients. Only suction evacuation was the treatment in 26 patients. Five patients required suction evacuation followed by chemotherapy. Two patients had abdominal hysterectomy due to advanced age. All the patients advised for regular follow up, but 18 (54.5%) patients attended regularly, 11 (33.3%) patients irregular follow up and 4 (12.1%) patients incomplete follow up. Among them 2 (6.1%) required second curettage due to incomplete evacuation, 4 (12.1%) patient required second curettage with chemotherapy. After 3 months 17 patients were free of any sign and symptoms.
Conclusion: Age >35 years and <21 years were the most common risk factors & most of the patients came from below average income group family. Early diagnosis by USG & early intervention is important for better outcome.
