Background: Gestational Trophoblastic Diseases (GTD) are a group of diseases in which the basic disorder lies in the abnormal development and growth of trophoblast. The success story of the GTD is the curability by chemotherapy ,mainly of tumours arising in the trophoblast ,the outlook of which used to be grave previously. The invasive nature of the trophoblast is self limited in normal gestation, thus differing in its essential nature from carcinoma. The mechanism of the aggressive growth pattern of the trophoblast and it'sself limitation is as poorly understood as is that of its malignant transformation.

Objectives of the study

1. To study the incidence of abortion and repeat vesicular mole following vesicular mole evacuation.
2. To study the fertility rate after vesicular mole evacuation and also following abortions after a vesicular mole.
3. To study whether increased incidence of abortion and repeat vesicular mole after chemotherapy.
4. To study whether increased incidence of congenital anomalies following vesicular mole evacuation.
5. To study whether there is any decrease in term deliveries in women who were given chemotherapy.

Study Setting and Design: The design adopted is descriptive research design.118 pregnant women with history of previous vesicular mole, who attended the Trophoblastic clinic of Sree Avittam Thirunal Hospital, Thiruvananthapuram are allocated. Medical records were kept for each patients. These 118 patients had 146 pregnancies during the period of study and 18 patients are still continuing with pregnancy and all of them have completed their fifth month of pregnancy.

Results: Data collected was analysed with descriptive statistics in percentage.

Conclusion: The present study shows that the proportion of abortion in patients who conceived following previous history of vesicular mole is 10.3% which comes in the usual normal range for normal population .Only 2.7% of patients with abortion after vesicular mole had subsequent normal pregnancy. Proportion of abortions (18.2%) and repeat vesicular mole (13.6%) is increased in patients who were not allowed pregnancy following a vesicular mole. Proportion  of abortion(20%) and repeat vesicular mole(20%) is more after chemotherapy .Proportion  of term pregnancy is slightly less (60%) in patients who were given chemotherapy than in patients who were not given chemotherapy .No congenital anomalies and still births were reported in this study.

Keywords: Vesicular mole, Gestational Trophoblastic, Diseases, Obstetric outcome.

1. Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C, ESMO Guidelines Working Group. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology. 2013 Sep 1;24(suppl_6):vi39-50.
2. Kohorn EI. The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment. International Journal of Gynecological Cancer. 2001 Jan 26;11(1):73-7.
3. Ngan HY, Bender H, Benedet JL, Jones H, Montruccoli GC, Pecorelli S, FIGO Committee on Gynecologic Oncology. Gestational trophoblastic neoplasia, FIGO 2000 staging and classification. International Journal of Gynecology& Obstetrics. 2003 Oct 1;83:175-7.
4. Schmid P, Nagai Y, Agarwal R, Hancock B, Savage PM, Sebire NJ, Lindsay I, Wells M, Fisher RA, Short D, Newlands ES. Prognostic markers and long-term outcome of placental-site trophoblastic tumours: a retrospective observational study. The Lancet. 2009 Jul 4;374(9683):48-55.
5. Hou JL, Wan XR, Xiang Y, Qi QW, Yang XY. Changes of clinical features in hydatidiform mole: analysis of 113 cases. The Journal of reproductive medicine. 2008 Aug;53(8):629-33.
6. Atrash HK, Hogue CJ, Grimes DA. Epidemiology of hydatidiform mole during early gestation. American journal of obstetrics and gynecology. 1986 Apr 1;154(4):906-9.
7. Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstetrics & Gynecology. 1995 Nov 1;86(5):775-9.
8. Thakur HS. Clinical study of vesicular mole. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017 Mar 30;6(4):1211-4.
9. Matsui H, Iitsuka Y, Suzuka K, Seki K, Sekiya S. Subsequent pregnancy outcome in patients with spontaneous resolution of HCG after evacuation of hydatidiform mole: comparison between complete and partial mole. Human Reproduction. 2001 Jun 1;16(6):1274-7.
10. Matsui H, Iitsuka Y, Suzuka K, Seki K, Sekiya S. Subsequent pregnancy outcome in patients with spontaneous resolution of HCG after evacuation of hydatidiform mole: comparison between complete and partial mole. Human Reproduction. 2001 Jun 1;16(6):1274-7.
11. Sebire NJ, Fisher RA, Foskett M, Rees H, Seckl MJ, Newlands ES. Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology. 2003 Jan 1;110(1):22-6.
12. Berkowitz RS, Im SS, Bernstein MR, Goldstein DP. Gestational trophoblastic disease. Subsequent pregnancy outcome, including repeat molar pregnancy. The Journal of reproductive medicine. 1998 Jan;43(1):81-6.
13. Matsui H, Iitsuka Y, Suzuka K, Yamazawa K, Tanaka N, Mitsuhashi A, Sekiya S. Early pregnancy outcomes after chemotherapy for gestational trophoblastic tumor. The Journal of reproductive medicine. 2004 Jul;49(7):531-4.

Dr Deepa M

Asst. Professor, Dept of O and G, SAT hospital, Govt. Medical College, Trivandrum