title: Epidemiology of Hydatidiform Moles in a Tertiary Hospital in Thailand over Two Decades: Impact of the National Health Policy.
abstract: BACKGROUND
  The incidence of hydatidiform mole (HM) differs among regions but has declined significantly over time. In Thailand, the initiation of universal health coverage in 2002 has resulted in a change of medical services countrywide. However, impacts of these policies on gestational trophoblastic disease (GTD) cases in Thailand have not been reported. This study aimed to find the incidence of hydatidiform mole (HM) in King Chulalongkorn Memorial Hospital (KCMH) from 1994-2013, comparing before and after the implementation of the universal coverage health policy.
  
  
  METHODS
  All cases of GTD in KCMH from 1994-2013 were reviewed from medical records. The incidence of HM, patient characteristics, treatment and remission rates were compared over two study decades between 1994-2003 and 2004-2013.
  
  
  RESULTS
  Hydatidiform mole cases decreased from 204 cases in the first decade to 111 cases in the seond decade. Overall incidence of HM was 1.70 per 1,000 deliveries. The incidence of HM in the first and second decades were 1.70 and 1.71 per 1,000 deliveries, respectively (p=0.65, 95%CI 1.54-1.88). Referred cases of nonmolar gestational trophoblastic neoplasia (GTN) increased from 12 (4.4%) to 23 (14.4%, p<0.01). Vaginal bleeding was the most common presenting symptom which decreased from 89.4% to 79.6% (p=0.02). Asymptomatic HM patients increased from 4.8% to 10.2% (p=0.07). Rate of postmolar GTN was 26%.
  
  
  CONCLUSIONS
  The number of HM cases in this study decreased over 2 decades but incidence was unchanged. Referral rates of malignant cases were more common after universal health coverage policy initiation. Classic clinical presentation was decreased significantly in the last decade.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand E-mail : drruang9@yahoo.com.
authors.forename: Varangkana
authors.initials: V
authors.lastname: Wairachpanich
authors.forename: Sompop
authors.initials: S
authors.lastname: Limpongsanurak
authors.forename: Ruangsak
authors.initials: R
authors.lastname: Lertkhachonsuk
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D031901:Gestational Trophoblastic Disease / Q000453:epidemiology* / Q000473:pathology; D006291:Health Policy; D006801:Humans; D006828:Hydatidiform Mole / Q000453:epidemiology* / Q000473:pathology; D015994:Incidence; D011159:Population Surveillance; D011247:Pregnancy; D011379:Prognosis; D062606:Tertiary Care Centers; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000473:pathology