TEMPLATE DESIGN © ‘’A profile of cases of Gestational Trophoblastic Neoplasia at a large tertiary centre in Dubai” Authors : Tasneem Husaini Rangwala MD, MRCOG, Faiza Mahgoub Badawi FRCOG. Department of Obstetrics and Gynaecology, Latifa (Al Wasl )Hospital, Dubai, UAE. Objectives MethodsResults 35 cases of GTD were seen in 2 years with 7000 deliveries / year, giving a prevalence of 1 / 400 live births. Age range: 17 – 49 yrs. Peak in 21 to 30 years age group.. Parity range- 0 to 10. majority in the parity group 1 to 4. 60% -local Arab nationals while 40% - expatriates Conclusions References OPTIONAL LOGO HERE Objectives were To study: (1)the prevalence of different types of gestational trophoblastic neoplasia (GTN) in the local and non local population of women at Latifa (Alwasl) hospital, a tertiary level referral centre for northern Emirates. (2)the safety of cervical preparation before uterine evacuation. (3)the role of repeat uterine evacuation in curing these cases. (4) the percentage of cases ultimately requiring chemotherapy.  GTD is rare but important pregnancy related disorder with an incidence of 1 in 400 in Asia and Latin America.  It is a spectrum varying from benign to malignant conditions..  It is a spectrum varying from benign Hydatidiform mole (complete, partial mole) to malignant conditions. ( invasive mole, choriocarcinoma and Placental Site Trophoblastic Tumour).  Majority of cases can be cured by simple surgical intervention.  Those cases requiring chemotherapy are generally cured with very low toxicity treatment.  Unlike other Gyn. malignancies fertility can be preserved and normal pregnancy outcome anticipated  Retrospective data collected for 2 years (from Jan Dec. 2008) for women admitted with suspected diagnosis of molar pregnancy at AWH.  The data from 35 files were reviewed to extract information.  Descriptive statistics used.  Cases were managed according to institutional protocol based on RCOG (Royal college of obstetricians and gynaecologists) guidelines HC no:AgeParitySymptomsSignsBaselineUSG findingsPrev. pregCx primingSuction EvOxytocin (Yrs.) Bleeding/LFD uterus/β-HCGMole/missed Yes/No vesiclesov cysts PAGE -1 Compli-β-HCG F/U2nd EvacoutcomeF/U durationhistopathologyBlood grp cationReg/Irregyes/Nocured/ need CT(months) PAGE -2 Previous pregnancy 1.Ka Yu Tse, Karen K L Chan, Kar Fai Tam, Hextan YS Ngan. Gestational Trophoblastic disease. Obstetrics, Gynecology and Reproductive medicine 2009; 19 issue 4: Philip savage. Molar Pregnancy.The obstetrician and Gynecologist 2008;10: N J Sebire, R A Fisher, M Foskett et al. Risk of Recurrence of Hydatidiform mole and subsequent pregnancy outcome following complete or partial Hydatidiform molar pregnancy. BJOG 2003; 110: Royal College of Obstetricians and gynaecologists. The management of Gestational Trophoblastic disease. RCOG Green Top Guideline NO. 38 May Pezeshki M, Hancock BW, Silcocks P, Everard J E et al.The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease. Gynecol oncol 2004; 95: Flam F, Lundstrom V, Petterson F.Medical induction prior to surgical evacuation of Hydatidiform mole. Is there a greater risk of persistent gestational trophoblastic disease? Eur J obstet gynecol reprod biol 1991; 42: B W L Tham, Everard J E, J A Tidy et al. Gestational Trophoblastic disease in the Asian population of Northern England and North Wales. BJOG 2003; 110: M stone, K D Bagshawe. An analysis of the influences of maternal age, gestational age, contraceptive method and the mode of primary treatment of patients with Hydatidiform mole on the incidence of subsequent chemotherapy.. BJOG 1979;86: Narendra pisal, John Tidy, Barry Hancock.. Gestational Trophoblastic disease. Is intensive follow up essential in all women? BJOG 2004; 12: N J Sebire, M Foskett, D Short, P Savage et al. Shortened duration of human chorionic gonadotrophin surveillance following complete or partial Hydatidiform mole: evidence for revised protocol of a UK regional trophoblastic disease unit.. BJOG 2007; 114:  35 cases of molar pregnancies were managed at AWH during 2 yr period from Jan to Dec  Incidence: 1/400  97.5% of cases had baseline β-HCG levels and initial ultrasound scan.  60% were cured by suction curettage alone,11% by second evacuation, 22.8% needed chemotherapy.  Default rate : 8.5 %  Complications were minor and seen in 11% cases.  Follow up was regular in 85.7% cases  Duration of follow up - <6 mths. in 37.1 % cases  There were 37% cases of complete mole and 48.5% cases of partial mole. No cases of invasive mole, choriocarcinoma or PSTT were seen in the study period.  1/12 cases that received cervical priming went on to have chemotherapy. 1. There should be a regional / national registry for GTD where all these cases are registered and receive appropriate follow up. 2. All cases should have a baseline β- HCG level and pelvic ultrasound before any intervention. 3. Caution during uterine evacuation can avoid serious complications. 4. Cervical preparation with prostaglandin should be done in selected cases and prolonged preparation should be avoided. 5. Repeat evacuation in selected cases avoids need for chemotherapy. 6. All cases of persistent GTD should have FIGO risk scoring and receive chemotherapy in specialised centres. 7. Follow up is ideal for one year but cases should be counselled for contraception and refrain from pregnancy for at least 6 months