Abstract

Background: Gestational trophoblastic disease encompasses several disease processes that originate in the placenta. Before 1969, metastatic choriocarcinoma was almost invariably fatal, whereas most patients are now cured and usually retain reproductive function. The basis for this dramatic change is earlier diagnosis, the ability to precisely measure human chorionic gonadotropin (hCG), and the availability of effective chemotherapy the cure rate is greater than 90% even in the presence of widespread metastasis^[1]. Precise follow-up of patients and precise monitoring using a reliable assay of hCG are essential to good results.

Aim of the study:  was to study the effect of pre evacuation Serum β hCG levels on the post evacuation regression of β hCG levels in molar pregnancy.

Methodology: This study was conducted for period of 1 year at a tertiary care center Sree Avittom Thirunal Hospital, Government Medical College, Trivandrum, a cohort of patients who attended the vesicular mole clinic  following evacuation of molar pregnancy  where recruited.

 Statistical tests used are mean, SD, Percentage, chi square and Odds Ratio to assess association of the selected parameters with delayed regression of serum β hCG levels in molar pregnancy.

Results: Of the 95 patients who met the inclusion criteria and recruited in this study of 28 were late regressers of β hCG included as cases and 67 were controls. Maximum number of cases in this study were in the age group of 20-30 years. Both the cases and controls were comparable with respect to age.( X2 =0.821 P=0.663) No significant association. In this study majority of the patients were Hindus.(X²=0.136 P=0.934)No statistically significant association was obtained with religion on β hCG regression. Majority of patients In this study belonged to low socio-economic status, (X²=4.135 P=0.04) low socio-economic status was found to be statistically significant. Blood group was not found to be an important factor affecting β hCG regression (X²=0.503 P=0.918).In this study, 60.7% of cases were Primi gravidas and among controls 55.2% were Primi gravidas. Previous conception was not found to be statistically significant.(X²=3.166 P=0.367).Period of gestation was not found to be an important factor affecting β hCG regression. (X²=0.778 P=0.477) Uterine size statistically significant effect on β hCG regression. In this study, 78.6% cases and only 34.3% controls had uterine size >POA. Odds ratio calculated was 7.014 CI=2.494 to 19.727 and X²=15.505 P=0.00. 32.1% of cases had moderate proliferation and 14.9% of controls had moderate proliferation. X²=2.476 P=0.29 Effect of trophoblastic proliferation was not found to be statistically significant. 50% cases had theca lutein cysts when compared to 26.9% of controls. X²=4.731 P=0.028 OR=2.722 CI=1.088 to 6.809.Presence of theca luetin cyst was found to be statistically significant.82.1% of cases in this study had complete moles, when compared to 56.7% of controls, X²=5.55 P=0.015 OR=3.511 CI=1.191 to 10.394 found to be statistically significant. In this study, 50% cases had β hCG >40,000 while only 20.9% controls had the same. This was found to be statistically significant, X²=8.047 P=0.05, Odds ratio was 3.78 CI=1.5 to 9.7. Level of pre-evacuation β hCG had Statistically significant effect on β hCG regression. 

Conclusion: Gestational trophoblastic neoplasia (GTN) is a highly curable group of pregnancy related tumours; approximately 50% of cases of GTN arise from molar pregnancy. The serial quantitative measurement of hCG is essential for the diagnosis, monitoring the efficacy of treatment, and follow -up of patients to detect a neoplastic change at the earliest.

Keywords- Gestational trophoblastic disease, Partial molar pregnancy, Complete molar pregnancy, human chorionic gonadotropin (hCG).