Management of gestational trophoblastic disease in developing countries.

Sivanesaratnam, V. (2003) Management of gestational trophoblastic disease in developing countries. Best Practice & Research Clinical Obstetrics & Gynaecology, 17 (6). pp. 925-42. DOI 14614890.

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In Malaysia, the incidence of molar pregnancy and gestational trophoblastic neoplasia is 2.8 and 1.59 per 1000 deliveries, respectively; the disease is more common among the Chinese compared to the Malays and Indians. While uterine suction is the preferred method of uterine evacuation of hydatidiform mole, complete evacuation was not achieved at the first attempt in 25% of cases. Partial moles comprise 30% of all moles; these need follow up similar to that for complete moles as they are potentially malignant. In the management of invasive moles, chemotherapy should not be withheld in the presence of metastases or failure of regression of hCG. Placental site tumours are rare. Prophylactic hysterectomy and prophylactic chemotherapy are not recommended. However, in those patients with unsatisfactory hCG regression curves indicating 'at risk' in developing gestational trophoblastic neoplasia (GTN), 'selective preventive chemotherapy' appears appropriate. Chemotherapy remains the main modality of treatment for GTN. As tumour bulk and location of disease are important determinants in outcome, we categorized our patients into low, medium- and high-risk groups with survivals of 100, 98 and 61.7% respectively. Surgery and radiotherapy have a limited role.

Item Type: Article
Additional Information: Department of Obstetrics and Gynaecology, University of Malaya, 50603 Kuala Lumpur, Malaysia.
Uncontrolled Keywords: Brain Neoplasms/secondary; Choriocarcinoma/prevention & control
Subjects: R Medicine
Depositing User: Mr. Faizal Hamzah
Date Deposited: 14 Jun 2011 04:13
Last Modified: 13 Mar 2013 08:44

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