Obstetric ultrasound aids prompt referral of gestational trophoblastic disease in marginalized populations on the Thailand-Myanmar border

• Published in: Global health action 2017, Vol.10 (1), p.1296727-1296727
• Main Authors: McGregor, Kathryn, Myat Min, Aung, Karunkonkowit, Noaeni, Keereechareon, Suporn, Tyrosvoutis, Mary Ellen, Tun, Nay Win, Rijken, Marcus J., Hoogenboom, Gabie, Boel, Machteld, Chotivanich, Kesinee, Nosten, François, McGready, Rose
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Blood; Evacuation; Female; Gestational trophoblastic disease; Gestational Trophoblastic Disease - diagnostic imaging; Gestational Trophoblastic Disease - therapy; Hemorrhage; Hospitals; Humans; hydatidiform; Hysterectomy; Income; Low income groups; Malaria; Marginality; Medical diagnosis; Middle Aged; molar pregnancy; Myanmar; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - therapy; Obstetrics; Original; Parasites; Pregnancy; Pregnancy complications; Pregnancy Complications, Neoplastic - diagnostic imaging; Pregnancy Complications, Neoplastic - therapy; Prenatal Care; Public health; Recurrence; refugee; Retrospective Studies; Rural communities; Rural Population; Survival; Thailand; Ultrasonic imaging; Ultrasonography - methods; ultrasound; Vector-borne diseases; Women; Womens health; Young Adult
• ISSN: 1654-9716; 1654-9880
• DOI: 10.1080/16549716.2017.1296727

Background: The use of obstetric ultrasound in the diagnosis of gestational trophoblastic disease (GTD) in high-income settings is well established, leading to prompt management and high survival rates. Evidence from low-income settings suggests ultrasound is essential in identifying complicated pregnancies, but with limited studies reviewing specific conditions including GTD. Objective: The aim of this study is to review the role of ultrasound in diagnosis and management of GTD in a marginalized population on the Thailand-Myanmar border. Antenatal ultrasound became available in this rural setting in 2001 and care for women with GTD has been provided by Thailand public hospitals for 20 years. Design: Retrospective record review. Results: The incidence of GTD was 103 of 57,004 pregnancies in Karen and Burmese women on the Thailand-Myanmar border from 1993-2013. This equates to a rate of 1.8 (95% CI 1.5-2.2) per 1000 or 1 in 553 pregnancies. Of the 102 women with known outcomes, one (1.0%) died of haemorrhage at home. The median number of days between first antenatal clinic attendance and referral to hospital was reduced from 20 (IQR 5-35; range 1-155) to 2 (IQR 2-6; range 1-179) days (p = 0.002) after the introduction of ultrasound. The proportion of severe outcomes (death and total abdominal hysterectomy) was 25% (3/12) before ultrasound compared to 8.9% (8/90) with ultrasound (p = 0.119). A recurrence rate of 2.5% (2/80) was observed in the assessable population. The presence of malaria parasites in maternal blood was not associated with GTD. Conclusions: The rate of GTD in pregnancy in this population is comparable to rates previously reported within South-East Asia. Referral time for uterine evacuation was significantly shorter for those women who had an ultrasound. Ultrasound is an effective method to improve diagnosis of GTD in low-income settings and an effort to increase availability in marginalized populations is required.