A 6-Year Review of Gestational Trophoblastic Disease in the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria

Background: Gestational Trophoblastic Disease (GTD) refers to a spectrum of diseases characterised by aberrant growth and development of the trophoblasts of the placenta that may continue even after the end of pregnancy.

Objective: To determine the prevalence, risk factors, clinical presentations and management of gestational trophoblastic disease in the Niger Delta University Teaching Hospital (NDUTH), Okolobiri, Bayelsa state, Nigeria .

Methodology: In this retrospective, descriptive, cross sectional study design, cases managed for gestational trophoblastic disease between January 2012 and December 2017 were audited using a self-developed proforma. Data collected include sociodemographic information, obstetric history, antenatal care in the index pregnancy, risk factors, management and outcome (morbidity and mortality) associated with gestational trophoblastic disease (GTD) in the Centre.

Results: There were 3172 deliveries that occurred during the 6year period under review in NDUTH with a total of 12 cases of GTDs. Hence, GTD is seen in 3.8 per 1,000 deliveries. The mean age of women with GTD was 31±6.3 years. Half of the women (50%) were in the low socio-economic class. The mean parity was 2 ± 1.6. The mean gestational age at presentation was 16.2 ± 5.4 weeks. All the women presented with amenorrhoea, Other presenting complaints include abnormal vaginal bleeding (83.0%) and uterine size greater than date (83.0%). Hydatidiform mole and choriocarcinoma accounted for 75.0% and 25.0% of cases, respectively. Seven (58%) of the patients had suction evacuation only for the management of hydatidiform mole, 1 patient (8.3%) had suction evacuation and chemotherapy for hydatidiform mole and subsequent persistent disease. Three (25%) of the patients had chemotherapy only for Choriocarcinoma. Ten (83.3%) of the patients were successfully treated. During the study period, 2 (17%) of the patients conceived after the treatment and had spontaneous vaginal delivery at term. Three (25%) of the patients made use of contraceptive pills during follow up. There were 2 maternal deaths due to GTD giving a case fatality rate of 6.7%.

Conclusion: GTDs though rare as shown in our study, they are however still associated with maternal mortality. This study underscores the need for histo-pathological examination of products of uterine evacuation. Urgent and intensified advocacy is needed in terms of good general education, poverty alleviation and improved health-seeking behaviour of our women to enhance early diagnosis, prompt and adequate treatment.