Gestational trophoblastic disease following complete hydatidiform mole in Mulago Hospital, Kampala, Uganda.
OBJECTIVE
To determine epidemiological characteristics and clinical presentation of complete hydatidiform mole (CHM) and complications associated with prophylactic chemotherapy with oral methotrexate.


METHODS
Mulago hospital, Kampala.


METHODS
Prospective study.


METHODS
Ninety-four patients with clinically and histologically confirmed complete hydatidiform mole admitted between 1/9/1995 and 30/1/1998 were followed for periods ranging from 12 months to 30 months. Seventy-eight (83.0%) received a total of 187 courses of oral methotrexate (0.4 mg/kg daily in 3 divided doses) as prophylactic chemotherapy. The main outcome measures were pre- and post-evacuation serum hCG levels and complications associated with oral methotrexate use.


RESULTS
The prevalence of CHM was 3.42 per 1000 deliveries. The mean age of subjects was 29.6 + 8.5 years. Eighteen women (19.1%) were nulliparous and mean gravidity was 8.3. Many women presented with high-risk disease. Risk factors for persistent trophoblastic disease were prior molar pregnancy, age<19 or >35 years and features of high-risk molar pregnancy. Twenty-four of the seventy-eight patients (30.7%) developed complications, mainly mucositis and haematological toxicity (leucopenia, anaemia and thrombocytopenia), commonly after 3 or more courses.


CONCLUSIONS
CHM was common and many patients presented with high-risk disease. Oral methotrexate for prophylactic chemotherapy was tolerable and safe for the first 2 courses, but serious complications occur as the duration of treatment increases. Prophylaxis did not prevent development of (or death from) metastatic trophoblastic disease.


CONCLUSIONS
Patients with CHM should be monitored for the development of post-evacuation trophoblastic disease. Those on prophylactic chemotherapy require close monitoring for the toxic effects of the drugs.
Kaye
Dan K
DK
Department of Obstetrics and Gynaecology, Makerere University Medical School, PO Box 7072, Kampala, Uganda. aogu@africaonline.co.ug
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D015994:Incidence; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate