scholarly journals Implementation and Monitoring of a Gestational Trophoblastic Disease Management Program in a Tertiary Hospital in Morocco: Opportunities and Challenges

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Imane Khachani ◽  
Mohamed Hassan Alami ◽  
Rachid Bezad
Keyword(s):  
Low Socioeconomic Status ◽  
Physical Space ◽  
Tertiary Hospital ◽  
Gestational Trophoblastic Disease ◽  
Management Program ◽  
Drop Out ◽  
Trophoblastic Disease ◽  
Resource Limited ◽  
Program Description

Objective. Gestational Trophoblastic Disease (GTD) management requires clear guidelines for diagnosis, treatment, and follow-up. Unequal management skills among practitioners, inadequate treatment, irregular surveillance, and drop-out are common in resource-limited settings and can lead to life-threatening complications and morbidities. To address these challenges, we implemented a GTD Management Program at the National Center for Reproductive Health in Rabat, Morocco. Methods and Program Description. In-depth review of management protocols was carried out, and concise guidelines were developed, with targeted training for physicians. A physical space and a weekly fixed GTD consultation were set, and personalized follow-up was established for each patient. An electronic database documenting patients’ surveillance was created, allowing immediate outreach in case of irregularities. Results. During the period from October 2013 to June 2016, 50 patients were included in this program. Patients’ mean age was 33 years; 92% were illiterate and 82% had a low socioeconomic status. 68% had a positive evolution, while 32% developed gestational trophoblastic neoplasia, requiring 2 to 6 chemotherapy sessions. An average of 2.8 outreach reminders were necessary for each patient. 94% fully adhered to the program of care and completed properly their follow-up. Conclusion. Implementation and thorough monitoring of this program helped optimize patients’ care, avoiding drop-outs and delays in diagnosing and treating complications.

A Study of Molar Pregnancy at Low Resource Settings of Tertiary Care Hospital Sindh

2021 ◽  
Vol 15 (7) ◽  
pp. 1547-1549
Author(s):  
Sabahat Fatima ◽  
A. G.ul Shaikh ◽  
Tahmina Mahar ◽  
Hameed-Ur-Rehman Bozdar ◽  
Sameena Memon ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Economic Status ◽  
Gestational Trophoblastic Disease ◽  
Common Symptom ◽  
Care Hospital ◽  
Molar Pregnancy ◽  
Socio Economic Status ◽  
Trophoblastic Disease

Aim: To determine the epidemiological factors/characteristics and clinical presentation of molar pregnancy Study design: Qualitative observational / retrospective study Place and duration: Department of Obstetrics and Gynaecology Unit-II, Ghulam Muhammad Mahar Medical College Sukkur from 1st January 2016 to 31st December 2020. Methodology: Forty five diagnosed cases with molar pregnancy and aged between 18-40 years were enrolled. Patient’s details demographics age, body mass index, parity and socio economic status were recorded. The total birth records and gynecological admission for the study period were also collected from the gynaecology and labour room record books case and operational registration data were obtained, descriptive statistics examined . Results: Mean age of the patients was 31.15±7.41 years with mean body mass index 26.16±7.22 kg/m2. Mean gestational age of the patients were 25.62±9.19 weeks. Twenty seven (60%) patients were multiparous and 18 (40%) were primiparous. 30 (66.7%) were illiterate and 15(33.3%) cases were literate. There were 14(31.11%) patients belonged lower class, 18 (40%) patients belonged middle and 13(28.9%) had high socioeconomic status. Twenty nine (64.4%) were from rural area and 16 (35.6%) were from urban area. Five (11.1%) patients had previous history of gestational trophoblastic disease. Abnormal vaginal bleeding was the most common symptom found in 34(75.5%) cases followed by lower abdominal pain found in 30 (66.7%) patients, hyperemesis found in 14(31.1%) and dyspnea in 9 (20%). Thirty six (80%) patients received suction evacuation and 9 (20%) cases referred. Forty one (91.1%) patients were recovered but the rest 4 (8.9%) were lost during follow up. Conclusion: Low/middle socio-economic status, illiteracy and cases from rural areas had multiparous parity was highly effected by molar pregnancy disease and it can be controlled by early diagnose to take regular follow-up by using suction evacuation. Key words: Gestational trophoblastic disease (GTD), Molar pregnancy, Primiparous, Multiparous

Gestational Trophoblastic Disease: Prevalence, Management and Follow-Up at a Tertiary Center in Oman—An 11-Year Study

2019 ◽  
Vol 17 (4) ◽  
Author(s):  
Fatma Al Wahaibi ◽  
Huda Al Ghaithi ◽  
Ruqiya AlShamsi ◽  
Vaidyanathan Gowri ◽  
Thuria Al Rawahi
Keyword(s):  
Gestational Trophoblastic Disease ◽  
Disease Prevalence ◽  
Trophoblastic Disease ◽  
Tertiary Center

Is there uniformity in definitions and treatment of gestational trophoblastic disease in Europe?

2019 ◽  
Vol 29 (1) ◽  
pp. 108-112 ◽  
Author(s):  
Minke M Frijstein ◽  
Christianne A R Lok ◽  
John Coulter ◽  
Nienke E van Trommel ◽  
Marianne J ten Kate – Booij ◽  
...  
Keyword(s):  
High Risk ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Gestational Trophoblastic Disease ◽  
Gestational Trophoblastic Neoplasia ◽  
Clinical Practices ◽  
Trophoblastic Disease ◽  
Consensus Statements ◽  
Definition Of

ObjectivesBecause gestational trophoblastic disease is rare, little evidence is available from randomized controlled trials on optimal treatment and follow-up. Treatment protocols vary within Europe, and even between different centers within countries. One of the goals of the European Organization for Treatment of Trophoblastic Diseases (EOTTD) is to harmonize treatment in Europe. To provide a basis for international standardization of definitions, treatment and follow-up protocols in gestational trophoblastic disease, we evaluated differences and similarities between protocols in EOTTD countries.MethodsMembers from each EOTTD country were asked to complete an online structured questionnaire comprising multiple-choice and multiple-answer questions. The following themes were discussed: incidence of gestational trophoblastic disease and gestational trophoblastic neoplasia, definitions, guidelines, classification system, treatment, recurrence, and follow-up.ResultsForty-four respondents from 17 countries participated in this study. Guidelines were present in 80% of the countries and the FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) staging and risk classification was often used to estimate risks. Agreement about when to start chemotherapy for post-molar gestational trophoblastic neoplasia was present among 66% of the respondents. Preferred first-line treatments in low- and high-risk gestational trophoblastic neoplasia were methotrexate (81%) and EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) (93%), respectively. The definition of human chorionic gonadotropin normalization after hydatidiform mole evacuation was two consecutive normal values for nine countries. The FIGO definition of post-molar gestational trophoblastic neoplasia based on human chorionic gonadotropin plateau or rise was agreed on by 69% of respondents, and only 69% and 74% defined low-risk and high-risk disease, respectively, using FIGO criteria. There were major differences in definitions of recurrence, chemotherapy resistance and follow-up protocols among countries, despite EOTTD consensus statements.ConclusionsThis questionnaire provides a good overview of current clinical practices in different countries. Based on the survey results, it is clear that there are several gestationaltrophoblastic disease-related topics that need urgent attention within the EOTTD community to create more uniformity and to aid the development of uniform guidelines in Europe.

Successful use of anti-retroviral therapy in combination with cytotoxic chemotherapy for persistent molar pregnancy: A case report

2003 ◽  
Vol 13 (2) ◽  
pp. 246-248
Author(s):  
M. Moodley ◽  
J. Moodley
Keyword(s):  
Case Report ◽  
Antiretroviral Therapy ◽  
Young Women ◽  
Ethical Dilemmas ◽  
Gestational Trophoblastic Disease ◽  
Cytotoxic Chemotherapy ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Response To Chemotherapy

Due to the HIV pandemic, the chances of finding gynecological malignancies in HIV-infected women are increased. This poses management and ethical dilemmas as the treatment for such malignancies are likely to further decrease their immunity. Gestational trophoblastic disease occurs predominantly among young women and has excellent response to chemotherapy. However, such therapy is not possible if their immunity (CD4 counts) is markedly depressed. The patient described presented with persistent molar pregnancy and had low CD4 count. She was given antiretroviral therapy and once the CD4 count had risen to acceptable levels cytotoxic chemotherapy was administered. She received a total of 13 cycles of chemotherapy with no significant untoward effects. After a 6-month follow-up period the patient was well with a negative serum βHCG level and CD4 count above 200. We conclude that HIV-infected women with gestational trophoblastic disease may be safely treated with cytotoxic chemotherapy provided anti-retroviral therapy is concurrently administered to boost immunity.

False-positive β-human chorionic gonadotropin values in the follow-up of gestational trophoblastic disease

2007 ◽  
Vol 9 (5) ◽  
pp. 332-334
Author(s):  
V. M. Díaz Muñoz de la Espada ◽  
J. A. Arranz Arija ◽  
P. Khosravi Shahi ◽  
S. Encinas García ◽  
R. Álvarez Álvarez ◽  
...  
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
False Positive ◽  
Gestational Trophoblastic Disease ◽  
Trophoblastic Disease

scholarly journals A case of methotrexate resistant gestational trophoblastic neoplasia

2018 ◽  
Vol 7 (12) ◽  
pp. 5178
Author(s):  
Sanjay Singh ◽  
Akhileshwar Singh ◽  
Shakti Vardhan
Keyword(s):  
High Risk ◽  
Combination Chemotherapy ◽  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Disease ◽  
Peripheral Hospital ◽  
Invasive Mole ◽  
Single Agent Chemotherapy

Gestational trophoblastic neoplasia (GTN) is a subset of gestational trophoblastic disease (GTD) which has a propensity to invade locally and metastasize. Patients with low risk GTN generally respond well to single agent chemotherapy (methotrexate (MTX) or actinomycin-D (ACT-D). However, high risk cases may develop resistance or may not respond to this first-line chemotherapy and are unlikely to be cured with single-agent therapy. Therefore, combination chemotherapy is used for treatment of these cases. Here we present a 25 years old P2 L2 A1 lady, who was initially treated at a peripheral hospital with multiple doses of Injection methotrexate with a working diagnosis of persistent trophoblastic disease. She didn’t respond to this treatment and reported to our centre for further management. On evaluation she was found to be a case of high risk GTN (invasive mole) (I:8) for which she was put on combination chemotherapy in the form of Etoposide-Methotrexate-Actinomycin-Cyclophosphamide-Oncovin (EMA-CO) regime. She responded to this treatment and is presently asymptomatic and is under regular follow up.

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