7- hesham sait - gtd final new

1. Hesham Sait
6th Medical student ,Faculty of medicine
King Abdulaziz University Hospital

2. Disclosure
 I have nothing to disclose.

3. Gestational Trophoblastic
Disease(GTD)
 It is an abnormal condition of the ovum
where there are partly degeneration and
partly hyperplastic changes in the young
chorionic villi, these result in the
formation of small cysts of varying size.

4. Gestational Trophoblastic
Disease (GTD)
Pre-Malignant
 Complete
Mole
 Partial Mole
Malignant
 Invasive mole
 Choriocarcin
oma
 Placental site
trophoblastic
tumorsSeckl et al Lancet 2000 and palmeiri et al Lancet 2005

5. Worldwide incidence of
molar pregnancy
Regions
Incidence/1000
pregnancies
North America and Europe 0.5–1
Asia and Middle East 1–12
Saudi Arabia 0.94–2.2
South Africa 0.87–4.88
West Africa and Nigeria 1.26

6. ∗ To estimate the prevalence
of (GTD) in the western
region of Saudi Arabia.
∗ To evaluate the success of
treatment and the effect
of age and risk group on
survival.

7. ∗ Retrospective Coherent study.
∗ All patients treated for GTD between January
2001and December 2010 were identified using KAUH
data base.
∗ Medical record was reviewed for age, parity,
clinical presentation and treatment outcome.
∗ Data entered in SPSS v20.
∗ Survival of patients with GTN were calculated
using Kaplain Mayer Test and Cox Regression were
used for independent variable.
∗ Patients with persistent disease were evaluated
according to their clinical treatment outcomes.
∗ Ethical approval were obtained.

8. Results

9. Demographic data of patients (n
= 122)Variable n
Age (years)
Mean ± SD (range) 31.52 ± 10.8 (15–56)
Parity
Median (range) 3 (0–7)
Gestational age (weeks)
Mean ± SD (Range) 12.42 ± 3.2 (4–22)
Pre-evacuation level of hCG
<100,000 u/ml
>100,000 u/ml
30 (25%)
92 (75%)
Median follow-up(months)
Range
24
12–72

11. Number %
Suction
Evacuatio
n
71 92.2
Hysterect
omy
6 7.8

12. Summary of patients who
underwent hysterectomy as initial
treatmentCas
e
Age
(years)
Parit
y (n)
Pathology
1 52 10 Complete mole
2 45 7 Complete mole
3 54 10 Complete mole
4 49 7 Complete mole
5 47 7 Complete mole
6 54 9 Complete mole

13. Persistent
GTD
%
Partial
mole
1 1.3
Complete
mole
19 24.6
All 20 25.9

14. Criteria used to diagnosed GTN
Plateauing of HCG level over at
least three weeks.
A 10% or greater rise in HCG for
three or more values over at
least two weeks.
Persistent of HCG six months
after molar evacuation.

15. All had two more cycles
after zero HCG
All had one more cycle
after zero HCG

17.  1st case: High risk GTN died 24
hours after admission to ICU
because of respiratory failure.
 2nd case: low risk died from RTA
few years after initial treatment
of Mtx.
 3rd case: low risk died from
chemotherapy toxicity thought
to be high risk was treated with
MAC.

18. Kaplain Mayer Test Comparison Wilcoxon Test P=0.69 (N/S)
Over-all 5 year survival
98%

19. P=0.49

20. ∗ We report the first survival data
for GTN in Saudi Arabia. However,
the overall incidence of GTD in
Saudi Arabia will be better
defined by establishment of a
GTD registry.

21. Acknowledgment
• Prof. Khalid Sait
• Dr. Nisren Anfnan
• Prof. Basem Aldeek

22. Thank You..