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|Title: ||Gestational prophoblastic disease following complete hydatidi-form mole in Mulago Hospital, Kampala, Uganda|
|Authors: ||Kaye, Dan K.|
|Keywords: ||Complete Hydatidiform Mole (CHM)|
|Issue Date: ||2002 |
|Publisher: ||Makerere University Medical School|
|Citation: ||Kaye, D.K. (2002). Gestational prophoblastic disease following complete hydatidi-form mole in Mulago Hospital, Kampala, Uganda. African Health Sciences, 2(2)|
|Abstract: ||Objectives: To determine epidemiological characteristics and clinical presentation of complete hydatidiform mole (CHM) and complications
associated with prophylactic chemotherapy with oral methotrexate.
Setting: Mulago hospital, Kampala.
Design: 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 postevacuation
serum hCG levels and complications associated with oral methotrexate use.
Results: The prevalence of CHM was 3.42 per 1,000 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.
Conclusion: 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.
Recommendations: 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.|
|Appears in Collections:||Research Articles (Health-Sciences)|
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