Treatment outcome analysis of molar pregnancy in tertiary care centre and its relation to referral pattern

Background: Gestational trophoblastic tumours commonly known as GTD are a group of placental tumours that are extremely sensitive to treatment with chemotherapy resulting in high success rate. This aspect of prognosis warrants a better understanding of barriers in good outcome in such patients.
Objective: To study the treatment outcomes of molar pregnancy referred from community hospital and treated in tertiary care centre
Method: Between 2017 and 2018, 178 cases of molar pregnancy cases were registered for follow-up in Gestational Trophoblastic (142 from our institution and 36 from community hospitals) Diseases clinic at Government Rajaji Hospital, Madurai, Tamil Nadu, India. All the cases enrolled were followed-up with clinical examination, hCG titre and abdominopelvic ultrasonography for suspected malignant mole. Number of repeat curettage and reason for repeat curettage, community as against institutional treatment and their relation to need for chemotherapy were studied.
Results: Out 178 patients, 38 (21 %) required chemotherapy with 20(11 %) developed WHO Low Risk Disease and 18 (10%) developed High Risk disease. Initial institutional management of molar pregnancy was suction evacuation in 142 cases were institutional cases and 36 cases of molar pregnancy had initial management in community hospitals. There was no repeat curettage in institutional cases. 8 out of 18 cases from community centers had a history of repeat evacuation. Two out of 26 (8%) low risk cases had repeat curettage and 6 out of 12 high risk cases had repeat curettage (50%) requiring EMA/CO Schedule. Time to referral for GTD Clinic for institutional was less than 1 week and the same for community cases was 9.11 weeks.
Conclusion: Repeat uterine curettage and evacuation in immediate post evacuation persistent residual intrauterine disease and delayed referral to tertiary care centre from peripheral community hospitals increases the chance of high-risk malignant mole requiring prolonged and intense chemotherapy.