Gestational trophoblastic disease is a common gynaecological problem in Malaysia. The incidence of molar pregnancy is 2.8 per 1000 deliveries, being more common amongst the Chinese. The preferred method of evacuation is suction curettage; complete evacuation of the uterus was not achieved at the first attempt in 25 per cent of cases. Partial moles in our centre comprised 30 per cent of all moles. This is potentially malignant and needs follow-up for a complete mole. In the management of an invasive mole, chemotherapy should not be withheld in the presence of metastases and failure of regression of hCG. The role of prophylactic hysterectomy and prophylactic chemotherapy in the management of molar pregnancy is discussed "Selective preventive chemotherapy" in patients at "risk" appears appropriate. Chemotherapy remains the main modality of treatment for gestational trophoblastic tumours (GTT). We categorised our patients into low, medium and high-risk groups; survivals were 100, 98, and 61.7 percent respectively. These patients when categorised according to FIGO staging had survivals of 100, 80, 78.6 and 68.2 per cent respectively for stages 1, 2, 3 and 4 respectively. The reasons for the poor survival in the 'high-risk' group are discussed. Colour doppler blood flow studies are now being carried out; its role needs further evaluation. Surgery and radiotherapy have only a limited role in the management of these cases.
A 25-year-old gravida 2 para 1 with 12-week amenorrhoea presented a second time for recurrent vomiting in pregnancy. She was diagnosed to have a missed miscarriage following absent fetal heart seen in an early scan. She opted for conservative management. However, on the third presentation, her vomiting continued. Repeated transvaginal ultrasound scan showed a fetus with a crown rump length of 19 mm, which is equivalent to 8 weeks and 4 days, with absence of fetal heart pulsation. Thyroid function tests and β human chorionic gonadotropin were then requested. Results showed that the patient's serum β human chorionic gonadotropin level was markedly raised to 147,000. A molar pregnancy was suspected. Her thyroid function tests came back normal. Suction curettage was performed and histopathology confirmed a partial molar pregnancy. On follow-up, the β human chorionic gonadotropin level was normal by 7 weeks after the curettage.
An invasive mole causing uterine perforation is a rare occurrence. We describe below a case with an unusual presentation which was mistaken for an ovarian tumour. The difficulty in diagnosis and the need for a high index of suspicion is highlighted.
Eighty-nine patients who had hydatidiform moles evacuated at the General Hospital, Kuala Lumpur, were followed with serum beta hCG determinations from October 1988 to June 1991. A regression curve for serum beta hCG, as measured by RIA, was derived from the results of 47 of the patients who demonstrated spontaneous regression of serum beta hCG titres. All 47 patients had normal serum titres at 135 days after evacuation. The mean time taken to reach normal level was 82.6 days, while the range was 39 to 135 days (5 to 19 weeks).
2a 2b dihomo 15(S) 15 methyl PGF2 alpha methyl ester (dihomo 15 me PGF2 alpha) in intramuscular doses of 0.5 mg 8 hourly was used in 631 patients with abnormal intrauterine pregnancy comprising 282 cases of intrauterine fetal death, 233 cases of missed abortion, 34 and 82 cases respectively anencephalic and molar pregnancies. The study was carried out as a collaborative project between the University Departments of Obstetrics and Gynaecology in Singapore (Singapore), Medan (Indonesia) and Kuala Lumpur (Malaysia) during the period June 1974 and November 1979. Six hundred patients (95.1%) aborted or delivered in a mean time of 11.3 hours (S.D. +/- 7.0) with an average of 1.8 injections of the prostaglandin analogue per patient. Side effects included vomiting (23.6%; mean 0.45 episodes per patient), diarrhoea (44.4%; mean 1.00 episode per patient), cold and shivering (11.9%) and pyrexia (12.4%). One patient sustained a cervical laceration which did not require repair. There were no complications.