Gestational Trophoblastic Disease Following Complete Hydatidi-form Mole in Mulago Hospital, Kampala, Uganda

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.