Management of Molar Pregnancy and its Association with Risk Factors in a Tertiary Level Hospital of Dhaka

Abstract

Background: Gestational trophoblastic diseases (GTD) are important causes of morbidity and mortality among women of reproductive age. However, their magnitude, clinical features, and associated risk factors are not well documented in our setting. Identifying risk factors and appropriate management may reduce morbidity and mortality. This study determined the risk factors associated with molar pregnancy and evaluated its management. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Shaheed Suhrawardy Medical College & Hospital, Dhaka, from July to December 2015. Thirty-three consecutive patients with molar pregnancy were included. Diagnosis was based on clinical examination, serum β-hCG, ultrasonography, and histopathological confirmation. Data on demographic characteristics, obstetric history, risk factors, presenting symptoms, treatment, complications, follow-up, and outcomes were collected using a predesigned questionnaire. Patients were followed for three months after discharge. Results: The mean age was 26.7 ± 7.2 years (range, 18–47 years); 48.5% were aged 21–35 years, 33.3% were below 21 years, and 18.2% were above 35 years. Most were multigravida (54.5%). The commonest presenting symptoms were per vaginal bleeding (75.8%) and amenorrhea (72.7%). Risk factors included age <21 or >35 years (51.5%), previous spontaneous abortion (12.1%), previous molar pregnancy (6.1%), and long-term oral contraceptive use (9.1%). All patients underwent suction evacuation and curettage; 78.8% required suction evacuation alone, 15.2% required subsequent chemotherapy, and 6.1% underwent abdominal hysterectomy. At three months, 51.5% were asymptomatic with normal serum β-hCG levels. Conclusion: Extremes of reproductive age were the most common risk factors, followed by previous spontaneous abortion and molar pregnancy. Per vaginal bleeding and amenorrhea were the predominant presentations. Suction evacuation was the main treatment modality. Regular follow-up with serum β-hCG monitoring is essential for early detection of persistent GTD and improved outcomes.