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Background: The incidence of molar pregnancy has demonstrated marked geographic and ethnic differences. This difference in the prevalence across various countries perhaps may depend upon the socioeconomic, genetic, nutritional and other cultural factors. In spite of having a higher prevalence among Asians, still epidemiological characteristics of Gestational Trophoblastic Disease (GTD) or Gestational Trophoblastic Neoplasia (GTN) are difficult to determine secondary to inconsistencies in case definitions and lack of centralised databases. Hence, this study was undertaken to determine the proportion and the clinical profile of women with hydatidiform mole from a South Indian population, where as of now there is limited data to enable us to detect and provide the standard of care for patients with GTN. Materials and Methods: A prospective cohort study between August 2014 to December 2015 and a retrospective review of medical records for the preceding 2 years from the year 2012 to 2014 was conducted in JIPMER to determine the proportion of women with molar pregnancy as well as to study the clinico-epidemiologic profile of hydatidiform mole. The study population comprised of a total of 116 cases, of which, 68 cases belonged to the prospective group and 48 cases to the retrospective group. The patients belonging to the prospective group (68) were followed up for a period of 6 months to note the trend of the β HCG and to detect the occurrence of GTN. The patients in the retrospective group (48) were considered only for analysing the clinical profile of hydatidiform mole, as follow up was not possible for this group of patients. Results: The proportion of molar pregnancy was calculated to be 2.07 per 1000 live births. Majority (59%) of the study population belonged to the age group of 18-23 years. Almost all the patients (98%) belonged to lower socioeconomic group. More than one-third (48%) of the patients were nulliparous. It was observed that, greater than half of the patients (56%) presented between 11-15 weeks of amenorrhoea. Majority (76%) of the patients had no previous abortions in their obstetric history. Only 4 (3.45%) patients had previous history of molar pregnancy. Abnormal uterine bleeding was the most common complaint noted in 79% of patients. Nausea and vomiting were noted in 62 patients, out of which 25 (40%) presented with hyperemesis requiring fluid and electrolyte correction. Anaemia was the most common medical complication noted in 55% of patients, followed by hyperthyroidism in 33% and hypertension in 2% patients. Among the 116 patients, 74(64%) had preevacuation HCG level more than 2,00,000mIU/ml. Suction evacuation was done in all the cases and 9 (8%) patients required re-evacuation in view of residual vesicular mole on a check scan. Among the 116 patients, histopathology revealed complete mole in 88% patients and partial mole in 12%. In the prospective group, following suction evacuation, 79% of the patients attained remission by the end of 6 months whereas in 13 patients (21%), hCG continued to either plateau or increase following the primary evacuation and they further developed GTN requiring chemotherapy. Out of the 13 cases of GTN, 7 patients attained remission with chemotherapy, whereas 6 patients failed to achieve remission during the 6 months' study period. Conclusion: Young, nulliparous women belonging to low socio-economic status had a higher proportion of hydatidiform mole. Improving the literacy rates, creating awareness among the women, early registration of pregnancy, prompt referral to higher centres and early administration of appropriate treatment, with a vigilant follow up would help in early detection of GTN.There is also a need for studies at country level which will give us a national figure on molar pregnancies. Thus, a standardized clinicoepidemiological profile of molar pregnancy in India can be created. [ABSTRACT FROM AUTHOR]

Background: Complete hydatidiform mole affects women in their reproductive age. About 15-20% develops persistent molar gestational trophoblastic neoplasia (GTN), which is linked with delayed (beyond 56 days) normalization of serum βHCG after surgical evacuation. Objective: The objective of the article is to shorten the duration of normalization time of βHCG with single-dose methotrexate injection in women with high risk complete hydatidiform mole (CHM) after suction evacuation. Methods: Total 76 women with CHM were randomized into intervention and control groups. In the intervention arm (n = 34) women received single dose 100 mg intramuscular methotrexate injection post evacuation and the control group (n = 42) had standard care. Surveillance was done in both groups at two weeks intervals for next six months and duration of normalization of βHCG level was recorded. Results: Total 94.7% women completed follow-up. Mean of normalization time was significantly lower in the intervention group compared to controls (9.7 weeks versus 14.7 week; P < 0.01). Time to event curve showed significantly earlier cumulative normalization time for the intervention group. Conclusion: Single-dose 100 mg methotrexate injection is a low-cost, simple intervention to help one out of three women with CHM with high-risk features to achieve normalization of βHCG within 56 days. This might be helpful for people in resource-poor countries where adherence to prolonged surveillance is poor. [ABSTRACT FROM AUTHOR]