See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/335984799

HYDATIDIFORM MOLE: INCIDENCE AND MANAGEMENT OUTCOMES IN A

TERTIARY HOSPITAL IN ABUJA

Article  in  EUROPEAN JOURNAL OF PHARMACEUTICAL AND MEDICAL RESEARCH · September 2019

CITATIONS READS

0 510

2 authors, including:

Habiba Ibrahim Abdullahi

University of Abuja
8 PUBLICATIONS   6 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Academic publications View project

All content following this page was uploaded by Habiba Ibrahim Abdullahi on 23 September 2019.

The user has requested enhancement of the downloaded file.

 ejpmr, 2018,5(6), 764-767 SJIF Impact Factor 4.897
Research Article
Abdullahi et al. EUROPEAN JOURNAL OF PHARMACEUTICAL
European Journal of Pharmaceutical and Medical Research
AND MEDICAL RESEARCH ISSN 2394-3211
www.ejpmr.com EJPMR

HYDATIDIFORM MOLE: INCIDENCE AND MANAGEMENT OUTCOMES IN A

TERTIARY HOSPITAL IN ABUJA

Dr. Mba GO and Dr. Abdullahi IH*

Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja.

*Corresponding Author: Dr. Abdullahi IH

Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja.

Article Received on 19/04/2018 Article Revised on 10/05/2018 Article Accepted on 01/06/2018

ABSTRACT
Background: Hydatidiform mole is an abnormal pregnancy of clinical and epidemiological importance because it
affects women in the reproductive age group and is potentially fatal with a lot of associated morbidities.
Objectives: To determine the incidence, clinical presentation and management outcome of Hydatidiform mole in
University of Abuja Teaching Hospital. Materials and Methods: It was a seven year retrospective study of
hydatidiform mole managed in University of Abuja Teaching Hospital between 1st January 2008 and 31st 2014.
Data were extracted from the ward and theatre registers as well as patients’ folders from the medical library and
analyzed using descriptive statistics. Results: There were 12,204 deliveries during the study period and 37 cases of
cases of hydatidiform mole giving an incidence of 0.3% (3 per 1000 deliveries). Majority of the patients were
teenagers (29.4%) and most (32.3%) were primipara. The most common clinical features were amenorrhoea
(94.1%) and bleeding per vaginam (88.2%). Seventeen cases (50.0%) had uteri larger than dates, while in 12 cases
(35.3%) the uterine sizes were smaller than dates. Ovarian enlargement was noted in 17.6% of the cases.
Complications in the form of haemorrhage occurred in 7 cases (20.6%). There were 3 cases (9.1%) of
choriocarcinoma, all of whom did not present at all for follow-up and two of the three subsequently had
hysterectomy due to excessive haemorrhage. Only two (6.1%) of the patients received chemotherapy. However, all
patients (100%) were managed surgically using suction evacuation. there was no death from GTD during the study
period. Conclusion: Hydatidiform mole is a remains an important cause of maternal morbidity in our Centre which
is largely due to poor and inadequate follow-up. Better outcome is possible with good patients’ counseling for
improved follow up care.

KEYWORDS: Gestational Trophoblastic Disease, Hydatidiform Mole, Molar Pregnancy, Uath.

INTRODUCTION The hydatidiform mole is characterized by wide spread

Hydatidiform mole also known as molar pregnancy is a and conspicuous proliferation of trophoblastic tissues
benign form of gestational trophoblastic disease (GTD) without overt invasion of adjacent structures.[3,5] It is
in which there is abnormal development of the commoner at the extremes of reproductive age.[2] Women
placenta.[¹] Gestational trophoblastic disease is a in their early teenage years, women older than 35 years
spectrum of placental disorders which include the benign or perimenopausal years are most at risk. It is also higher
partial and complete moles and the malignant invasive in nulliparous women, in patients of low economic
mole, choriocarcinoma and placenta site tumours.[1-2] status, women with previous history of molar pregnancy
and in women whose diet are deficient in protein, folic
The hydatidiform mole is classified into two, complete acid, and carotene. [6]
and incomplete moles based on the morphology,
karyotype and histologic appearance. The hydatidiform The incidence of hydatidiform mole has a world wide
mole results from an abnormal pregnancy in which an variation, reported as 0.5-2.5/1000 pregnancies being
anuclear ovum is fertilized. It is a complete mole when highest in the far East.[7] In Nigeria, a figure of 1 in 379
an empty ovum is fertilized by a haploid 23X sperm deliveries has been reported.[8]
(which duplicates its chromosomes to yield a 46xx
complement), or the anuclear ovum is fertilized by two The diagnosis, counseling on contraception and potential
sperm (23X and 23Y) to yield a 46xy karyotype. [1-3] The chemotherapy are demoralizing and could be devastating
partial moles are triploid (69XXX or 69XXY) with two to a young woman eager to replace the lost pregnancy.
sets of paternal and one set of maternal chromosomes. [4] The Royal college of Obstetrician and Gynaecologists
recommends that suspected complete molar pregnancies
should be removed by suction evacuation, while

www.ejpmr.com 764
Abdullahi et al. European Journal of Pharmaceutical and Medical Research

suspected partial molar pregnancy should generally be Table. 2: Parity Distribution of Patients.
removed via medical termination as the fetal parts can Parity Number Percentage
present an obstacle to suction evacuation.[9] However, 0 5 14.7
hysterectomy remains an option for patients with 1 11 32.3
uncontrollable haemorrhage.[6] 2 7 20.6
3 4 11.8
Following evacuation, in the majority of cases, the 4 2 5.9
residual trophoblast cells are unable to proliferate for ≥5 5 14.7
long, and fall in serum beta human chorionic Total 34 100
gonadotrophin (β-hCG) level is a very good estimation
of declining activity.[¹0-14] Whether or not prophylactic The parity of the patients ranged from 0 to 7. The
chemotherapy following evacuation of complete primiparous patients had the highest (32.3%) incidence
hydatidiform mole should be offered to patients of hydatidiform mole in this study. Both nulliparous and
considered to be at high risk for persistent gestational grandmultiparous groups had equal cases (14.7%) each.
trophoblastic disease or whom poor follow-up is
anticipated remains controversial.[6] Follow up of patients Table. 3: Clinical Features of Hydatidiform Mole.
with molar pregnancy in developing countries like ours Clinical features Number Percentage
is often challenging due to ignorance and poverty. It is
Amenorrhea 32 94.1
against this backdrop, that this study which aims to
Vaginal bleeding 30 88.2
determine the incidence, clinical presentation and
Excessive vomiting 4 11.8
outcome of management of hydatidiform mole in the
University of Abuja Teaching Hospital was undertaken. Lower abdominal pain 12 52.9
Anaemia 6 17.6
MATERIALS AND METHODS Pregnancy induced 1 2.9
This was a 7 year retrospective study of all the hypertension
hydatidiform moles managed between January 2008 and
December 2014 at University of Abuja Teaching Table. 4: Uterine Size.
Hospital, Gwagwalada. Information was obtained from Uterine size Number Percentage
the gynecological ward register, theatre records and Larger than date 17 50
patients’ case notes. Information retrieved included Smaller than date 12 35.3
socio-demography characteristics, clinical presentations, Appropriate for date 5 14.7
and mode of diagnosis, management outcomes and Total 34 100
follow-up with serum β-hCG.
Amenorrhoea was the commonest clinical presentation in
RESULTS this study as it occurred in 32 (94.1%) of the cases. This
During the study period, there were a total of 37 cases of was followed closely by bleeding per vaginam which
molar pregnancies diagnosed and treated in this Centre. was seen in 30(88.2%) of the patients. Uterine size larger
However, only 34 case notes (91.9%) were retrieved and than the gestational age was seen in 17 (50%) and
analyzed. The total number of deliveries during the study smaller than gestational age in 12 (32.3%) of cases.
was 12,204 giving an incidence rate for hydatidiform There was ovarian enlargement in 6 (17.6%) of the cases.
mole of 0.3% (1 in 329).
Table. 4: Complications of Hydatidiform Mole.
Table. 1: Age Distribution of the Patients. Complication Number Percentage
Age (years) No % Haemorrhage 7 20.6
≤20 10 29.4 Sepsis 1 2.9
20-25 7 20.6 Thyrotoxicosis 0 0
26-30 4 11.8 Invasive mole 0 0
31-35 8 23.5 Choriocarcinoma 3 8.8
36-40 5 14.7 Hysterectomy 2 5.9
Total 34 100
Haemorrhage was a complication of hydatidiform mole
The patients’ age ranged from 14-40 years. Hydatidiform in 7 (20.6%) of the cases. Three of the cases (9.1%)
mole was highest (29.4%) among the teenagers followed developed choriocarcinoma 2(6.1%) of whom had
by 23.5% seen in patients who were between 31-35 hysterectomy. There were no cases of sepsis,
years. The lowest (11.8%) was recorded in the age group thyrotoxicosis or invasive mole recorded in the study.
of 26-30 years.

www.ejpmr.com 765
Abdullahi et al. European Journal of Pharmaceutical and Medical Research

Table. 4: Duration of Follow-up. minimal blood loss.[26] It also provides specimen for
Duration (months) Number Percentage histological assessment of the product of conception,
0 20 58.9 reduces the danger of uterine perforation, minimizes
1 8 23.5 injury to the blood vessels and therefore reduces the
2-5 5 14.7 chance of trophoblastic tissue embolism.[26] It is also
6-11 1 2.9 associated with a low risk of chemotherapy usage for
≥12 0 0 gestational trophoblastic malignancy. [26]
Total 34 100
Majority (58.9%) of the patient did not present for Haemorrhage is one of the commonest complications of
follow-up and none was followed-up for up to 1 year. hydatidiform mole and occurred in 7(20.6%) of the cases
in this study. There 3(8.8%) cases of choriocarcinoma
DISCUSSION out of which 2(5.9%) had subtotal hysterectomy due to
The incidence of hydatidiform mole in this study was uncontrollable haemorrhage. This was comparable to
0.3% (1:329) which is almost similar to 1:357 in Jos, findings from Kano where 10.5% progressed to
north-central Nigeria, but higher than that from Zaria choriocarcinoma.[27] These patients that had
(1:452), Port Harcourt (0.23%) and Ile-Ife (0.2%), choriocarcinoma never presented for follow-up; two
Nigeria.[12,15-17] It is however, lower than 0.4% in Nnewi, (5.9%) of them received EMACO regimen and one
0.58% in Lagos, 0.54% in Ibadan, all in Nigeria.[18-20] (2.9%) had methotrexate.
The reason for this geographical variation is unknown
but the fact that these are hospital based studies in The follow-up rate was as low as 38.2% which was
tertiary referral Centers in an environment with varying similar to 32% found in Jos study and findings of other
degrees of hospital utilization may be contributory. authors in different part of Nigeria all corroborated the
Indonesia has one of the highest incidence of fact that the follow-up of patients in our environment is
hydatidiform mole (1:57).[3] poor.[12,17,20,23] Only one patient was followed-up beyond
6 months and none up to 1 year.
Maternal age is associated with risk of hydatidiform
mole with higher incidence among women under the age Hydatidiform mole remains an important cause of
of 20 years and rising after the of 40 years.[21] This is maternal morbidity in our Centre which is largely due to
partly supported by findings in this study as 29% of the poor and inadequate follow-up. Better outcome is
patients were teenagers. However, none of the patients in possible with good patients’ counseling for improved
this study was over 40 years. follow up.

Primiparas formed the largest proportion of the patients REFERENCES

(32.3%) in this study. This is at Variance with the reports 1. Seckl MJ, Sebire NJ, Berkowitz RS. Gestational
from some authors where most patients were of high trophpblastic disease. Lancet, 2010; 376(9742):
parity.[19,22] Other authors however found no significant 717-729.
association with parity.[23,24] Majority of the patients 2. Savage P, Seckl M. Trophoblastic disease. In:
(94.1%) presented with amenorrhoea making it the Edmond DK, editor. Textbook Obstetrics and
commonest presenting complaint in this study. This was Gynaecology for postgraduates. 7th edition. London:
followed by vaginal bleeding (88.2%). This agrees with Blackwell scientific publications, 2007; 117-124.
the documentations in the literature where more than 3. Berkowitz RS, Goldstein DP. Gestational
90% of the patients with molar pregnancy presented with trophoblastic disease. In: Rayan KJ, Berkowitz RS,
abnormal vaginal bleeding.[24,25] Lower abdominal pain Baribieri Dunaif A, editors. Kistners Gynaecology
was also found to be a common complaint as it was seen and women’s health. 7th edition. St Louis Missouri:
in 52% of the cases. It is therefore necessary for all Mosby Inc, 1990; 218-230.
patients with such complaints in early pregnancy to have 4. Bagshawe KO, Lawlar SD. Hydatidiform mole and
an ultrasound scan which is reliable in the diagnosis of Choriocarcinoma. In: Shaw RW, Souter WP, Staton
this condition.[23] Ultrasound was used in the diagnosis of SL. Gynaecology. Edinburgh: Church Livingstone,
82.6% of the cases in this study. It has also aided earlier 1992; 453-468.
diagnosis especially in the first trimester. Other clinical 5. Ozalp SS, Yalcin OT, Tanir HM. Hydtidiform mole
features seen in this study were pregnancy induced in Turkey from 1932 to 2000.Int. Gynae Obstet,
hypertension (2.9%) and hyperemesis gravidarum 2001; 73: 257-258.
(11.8%). Uterine size larger than the dates was found in 6. Aghajanian P. Gestational trophoblastic disease. In:
50% of the cases, while 35.3% were found to be smaller Decherney AH, Nathan L, Goodwin TM, Laufer N,
than the dates and 14.7% compatible. editors. Current Diagnosis and Treatment in
Obstetrics and Gynaecology. 10th edition. New
Suction curettage was the method of uterine evacuation York: McGraw Hill medical publishing Division,
in all the patients in this study. This is the recommended 2007; 887-895.
management modality because it allows for rapid
evacuation of the uterus irrespective of uterine size with

www.ejpmr.com 766
 Abdullahi et al. European Journal of Pharmaceutical and Medical Research

7. Srangsriwong S. Molar pregnancy in 24. Obiechina NJ, Udigwe GO, Obi RA. Molar
Sappasithiprasong hospital. Med J Ubon Hospital, Pregnancy: A ten year review at Onitsha, Nigeria. J
1995; 16: 187-194. invest Pract, 2001; 3: 26-31.
8. Agboola A. Trophoblastic tumours. Textbooks of 25. Audu BM, Takai IU, Chama CM, Bukar M, Kyari
Obstetrics and Gynaecology for medical students. O. Hydatidiform mole as seen in a University
2nd edition. Ibadan: Heinemann Educational books teaching Hospital: A 10-year review. J Obstet
Nigerian Plc, 2006; 218-224. Gynaecol, 2009; 29: 322-25.
9. Royal college of Obtetricians and Gynaecologist. 26. Garret LA, Garner EI, Feltmate CM, Goldstein DP,
Management of Gestational Trophoblastic Berkowitz RS. Subsequent pregnancy outcomes in
Neoplasia.Green Top guideline No. 38. London: patients with molar pregnancy and persistent
RCOG, 2004. gestational trophoblastic neoplasia. J Reprod Med.,
10. Barut A, Arikan I, Harma MI, Barut F, Coskan A. 2008; 53: 481-486.
Recurrent partial hydatidiform mole. Paed Med 27. Avidime AR, Zakari M. Hydatidiform mole in
Assoc, 2011; 61: 1016-1017. Aminu Kano teaching hospital, Northwestern
11. Mayun AA. Hydatidiform mole in Gombe: A five Nigeria: A 5 year review. Trop J Obstet Gynacol,
year Histopathological review. Niger J clini Pract, 2014; 31(2): 69-73.
2008; 11: 134-138. 28. .Kerkmeijer L, Wielsma S, Bekkers R, Pyman J, Tan
12. Ocheke AN, Musa J, Uamai AO. Hydatidiform mole J, Quinn M. Guidelines following hydatidiform
in Jos, Nigeria. Nger Med J., 2011; 52: 223-225. mole: A reappraisal. Aust NZJ Obstet Gynaecol,
13. Shazyl SA, Ali MK, Abdel Badee AY, Alsokkary 2006; 46: 119-23.
AB, Khodary MM, Mostafa NA. Twin Pregnancy
with complete hydatidiform mole and co-existing
fetus following ovulation induction with a non-
precribed clomiphene citrate regimen: A case report.
J Med case Rep., 2012; 6: 95.
14. Savage P. Molar pregnancy. The Obstetrician and
Gynaecologist, 2008; 10: 3-8.
15. Kolawole AO, Nwajagu J, Oguntayo AO, Zayyan
MS, Adewuyi S. Gestational trophoblastic disease in
Abuth Zaria, Nigeria: A 5 year review. Trop J
Obstet Gynaecol, 2016; 33(2): 209-15.
16. Nyengidiki TK, Bassey G, Inimgba NM, Orazulike
NC, Amadi O. A five year review of gestational
trophoblastic diseases in Port Harcourt, Nigeria. Ph
Med J., 2016; 10(1): 18-24.
17. Eniola OA, Mabayoje P, Ogunniyi SO.
Hydatidiform mole in Ile-Ife, Nigeria: A 10-year
review. Obstet Gynaecol, 2001; 21: 405-207.
18. Igwegbe AO, Eleje GU. Hydatidiform mole: A
review of management outcome in a Tertiary
Hospital in South East, Nigeria. Ann Med Health
Sci. Res., 2013; 3(2): 210-214.
19. Agboola A, Abudu O. Some epidermiological aspect
of Trophoblastic disease in Lagos. Niger Med pract,
1984; 8: 29-31.
20. Ogunbode O. Benign hydatidiform mole in Ibadan,
Nigeria. Int J Gynaecol Obstet, 1978; 15: 387-390.
21. Nevin J. Gestational trophoblastic disease. In: Bloch
B, Dehaeck K, Soeters R, editors. Manual of
practical Gynaecological oncology. London:
Chapman and Hall medical, 1995; 130-146.
22. Aboyeji AP, Ijaiya MA. Hydatidiform mole in
Ilorin, Nigeria: A 10-year review. Niger J Med.,
2000; 9: 56-59.
23. Mbamara SU, Obiechina NJ, Eleje GU, Akabuike
CJ, Umeononihu OS. Gestational trophoblastic
disease in a Tertiary Hospital in Nnewi, Southeast
Nigeria. Niger med J., 2009; 50: 87-89.

www.ejpmr.com 767

View publication stats