Epidemiological, Clinical, and Therapeutic Characteristics of Gestational Trophoblastic Disease in Eastern Madagascar: A Retrospective Study at a Tertiary Referral Center

Abstract

Background: Gestational trophoblastic disease (GTD) comprises a spectrum of pregnancy-related disorders with marked geographical variation in incidence, being more frequent in low- and middle-income countries. Data from eastern Madagascar remain limited. Objective: To describe the epidemiological, clinical, paraclinical, and therapeutic characteristics of GTD managed at a tertiary referral hospital in eastern Madagascar. Methods: A retrospective descriptive study was conducted over a six-year period (January 2019 to December 2024) at the University Hospital Center of Analankininina Toamasina (CHUAT). All patients diagnosed with GTD based on histopathological findings and/or biological follow-up were included. Data were collected from medical records and analyzed using descriptive statistics. Results: A total of 53 cases of GTD were identified, including 42 hydatidiform moles and 11 cases of gestational trophoblastic neoplasia (GTN). The mean age was 29 ± 8.5 years, with a predominance of women aged 20 - 29 years. Vaginal bleeding was the most common presenting symptom (31/53). Initial serum human chorionic gonadotropin (hCG) levels exceeded 100,000 IU/L in 27 cases. According to FIGO scoring, 6 cases were classified as low risk and 5 as high risk. Uterine evacuation by curettage was performed in 41 patients. Chemotherapy was administered in all GTN cases. Complete remission was achieved in 41 patients, while 3 deaths were recorded. Subsequent pregnancy occurred in 13 patients. Conclusion: GTD remains a significant health concern in eastern Madagascar, often diagnosed at advanced stages. Despite resource limitations, favorable outcomes can be achieved with appropriate management. Strengthening early diagnosis, pathology services, and follow-up systems is essential to improving prognosis.