Molar pregnancy, a subset of gestational trophoblastic disease (GTD), is a rare condition characterized by abnormal proliferation of trophoblastic tissue, resulting in complete or partial hydatidiform moles. It has a higher prevalence in developing countries, particularly across South Asia, due to sociode mographic and nutritional risk factors [1]. Epidemiological studies from tertiary centres in South Asia have consistently reported variable incidence rates, with molar pregnancies contributing significantly to early pregnancy loss [2].

Clinically, molar pregnancies are often diagnosed in the first trimester and may present with vaginal bleeding, hyperemesis gravidarum, and uterine size larger than gestational age. In a retrospective review conducted in Eastern Nepal, most cases were diagnosed based on typical clinical presentation and ultrasound findings, emphasizing the need for timely recognition [3]. Similarly, a study from Bangladesh identified maternal age extremes, prior molar pregnancies, and low socioeconomic status as key risk factors, reinforcing the role of community-level screening in vulnerable populations [4].

Globally, a bibliometric analysis tracing five decades of research on molar pregnancy has highlighted increasing attention to regional disparities and evolving diagnostic tools [5]. In Pakistan, geographic and clinical variations in presentation were documented, underlining the need for locally contextualized data to guide early intervention strategies [6]. Furthermore, an updated review has consolidated knowledge on epidemiology, diagnosis, and follow-up care, advocating for standardized surveillance to prevent progression to malignant gestational trophoblastic neoplasia [7].

Despite the growing body of literature, data from smaller Indian district hospitals remain scarce. This study, conducted at Government General Hospital, Siddipet, aims to fill this gap by examining the incidence and associated risk factors for molar pregnancy over an 18-month period in a cross-sectional design

AIMS AND OBJECTIVES

The aim of this cross-sectional study was to determine the incidence and identify potential risk factors associated with molar pregnancy among antenatal patients at Government General Hospital, Siddipet. Conducted over an 18-month period, this study specifically sought to assess the demographic and clinical characteristics of women diagnosed with molar pregnancy, including maternal age, parity, socioeconomic status, and nutritional background. Additionally, it aimed to evaluate presenting symptoms, gestational age at diagnosis, and prior reproductive history to determine patterns that could inform early detection and prevention strategies in a district-level healthcare setting.

Study Design and Setting

This was a cross-sectional observational study conducted in the Department of Obstetrics and Gynaecology at Government General Hospital (GGH), Siddipet, over a period of 18 months. The study aimed to determine the incidence and associated risk factors of molar pregnancy among antenatal patients attending the hospital.

Inclusion and Exclusion Criteria

All women diagnosed with molar pregnancy based on clinical features, ultrasonographic findings, and histopathological confirmation during the study period were included. Exclusion criteria comprised patients with incomplete medical records, non-consenting individuals, and cases subsequently identified as non-molar gestations on histopathology.

Data Collection and Variables

Data were collected retrospectively and prospectively from hospital medical records and antenatal registers. The variables collected included:

• Demographic variables: Age, parity, socioeconomic status, literacy level, and nutritional status.
• Clinical variables: Gestational age at diagnosis, presenting symptoms (e.g., vaginal bleeding, hyperemesis), uterine size, and ultrasonographic findings.
• Obstetric history: Previous molar pregnancy, abortions, or live births.
• Outcome variables: Type of molar pregnancy (complete or partial), management approach, and immediate complications (e.g., haemorrhage, need for transfusion).

Data were recorded at the time of diagnosis and continued until the point of definitive management or discharge.

Statistical Analysis

Descriptive statistics were applied to summarize demographic and clinical characteristics. Continuous variables were expressed as means with standard deviations or medians with interquartile ranges, depending on distribution. Categorical variables were presented as frequencies and percentages. The association between risk factors and molar pregnancy was analyzed using the Chi-square test or Fisher’s exact test for categorical data. Independent t-tests or Mann-Whitney U tests were used for comparing continuous variables. Statistical analysis was performed using IBM SPSS Statistics version 29.0 and R version 4.3.3, with a p-value of <0.05 considered statistically significant.

Ethical Considerations

The study was approved by the Institutional Ethics Committee of GGH Siddipet. All data were anonymized and handled in accordance with ethical standards to protect patient confidentiality.

1. Incidence of Molar Pregnancy at GGH Siddipet

During the 18-month study period at Government General Hospital, Siddipet, a total of 8,247 antenatal patients were recorded. Among these, 20 women were diagnosed with molar pregnancy, yielding an incidence of 2.42 per 1,000 antenatal admissions.

Table 1: Incidence of Molar Pregnancy

2. Demographic Profile of Affected Women

Among the 20 women diagnosed with molar pregnancy, the most represented age group was above 35 years (40%), followed by 21–25 years (20%) and <20 years (15%). Nearly half the women were primigravida or para 1, with 40% having parity of 1. The majority belonged to the low socioeconomic group (70%), and 55% had only primary-level education. Nutritional status was reported as poor in 40% and average in 45% of cases.

Table 2: Demographic Profile of Affected Women

3. Clinical Presentation

The most common presenting symptom among women diagnosed with molar pregnancy was uterine enlargement, reported in 55% of cases, followed closely by vaginal bleeding (50%) and hyperemesis (50%). Notably, 35% of the patients were asymptomatic at the time of diagnosis, with molar changes detected incidentally during routine ultrasound.

Table 3: Presenting Symptoms of Molar Pregnancy (n = 20)

4. Obstetric History and Risk Factors

Among the 20 women with molar pregnancy, only 1 case (5.0%) had a history of prior molar gestation. A history of abortion was reported in 70% of the cases, while 30% had no previous abortions. Regarding parity, 40% were primigravida (P0), and 40% had parity 1.A breakdown of prior pregnancy outcomes revealed that 40% had abortions only, 30% had a combination of abortions and live births, and 25% had only live births. Prior molar pregnancy was identified in one patient, accounting for 5% of the cohort.

Table 4: Obstetric History Summary (n = 20)

Statistical Association between Risk Factors and Mole Type

1. History of Abortion vs. Mole Type

• Test used: Fisher’s Exact Test
• Contingency Table:

• Odds Ratio: 2.75
• p-value: 0.586
• Interpretation: No statistically significant association was found.

2. Age Group vs. Mole Type

• Test used: Chi-square Test
• Degrees of Freedom (df): 4
• χ² value: 1.
• 75
• p-value: 0.782
• Interpretation: No statistically significant association was found between age group and type of molar pregnancy.

5. Gestational Age and Type of Mole at Diagnosis

The mean gestational age at diagnosis was 10.83 weeks for complete moles and 9.92 weeks for partial moles. The interquartile range was slightly wider among complete mole cases (IQR: 8.95–11.68 weeks) compared to partial mole cases (IQR: 8.73–10.83 weeks).

A Mann–Whitney U test was conducted to compare gestational age distributions between the two groups, yielding a U statistic =

49.5 and p-value = 0.564, indicating no statistically significant

difference in gestational age at diagnosis between complete and partial moles.

Descriptive Statistics: Gestational Age by Mole Type

6. Immediate Complications and Management

Among the 20 molar pregnancy cases, haemorrhage was observed in 5 patients (25%), and 2 patients (10%) required blood transfusion. Suction evacuation was the primary treatment modality, used in 80% (n = 16) of cases, while medical management was employed in 20% (n = 4).

When stratified by mole type, haemorrhage occurred in 4 out of 14 complete mole cases (28.6%) and in 1 of 6 partial mole cases (16.7%). Blood transfusion was needed in 2 complete mole cases and none of the partial mole group.

A Fisher’s Exact Test revealed no significant association between mole type and haemorrhage (p = 1.000) or between mole type and transfusion requirement (p = 1.000).

Table 6A: Complication Frequency by Mole Type

Table 6B: Transfusion Requirement by Mole Type

Table 6C: Treatment Modality by Mole Type

7. Summary of Key Risk Factor Associations

A review of key demographic and clinical risk factors revealed several patterns among the 20 molar pregnancy cases. Of the 14 women with complete moles, 64.3% (n = 9) had a history of abortion, and 42.9% (n = 6) were older than 35 years. Poor nutritional status and low socioeconomic status were each observed in approximately 64% (n = 9) of complete mole cases. While these trends suggest clustering of risk in certain subgroups, no statistically significant associations were identified in earlier bivariate analysis due to the small sample size.

Table 7: Selected Risk Factor Distribution by Mole Type

Incidence and Epidemiological Context

The incidence of molar pregnancy in our study was 2.42 per 1,000 antenatal admissions, consistent with rates reported from low- to middle-income countries. For example, Branch [8] and Fatima et al. [10] reported comparable incidences in Indian and Pakistani populations. In contrast, Strohl and Lurain [15] described lower rates (0.6–1.1 per 1,000) in high-resource settings. These findings underscore persistent global disparities, possibly driven by nutritional and socioeconomic determinants.

Demographic and Socioeconomic Patterns

In our cohort, 40% of cases occurred in women above 35 years, a recognized risk group for molar gestation. This is in agreement with findings from Alimohammadi et al. [9,13] and Nahar [14], who highlighted maternal age and low socioeconomic status as prominent risk factors. Similarly, 70% of our patients were from low SES backgrounds, and 55% had only primary education, findings echoed in Fatima et al. [10] and Sujatha [12], where lack of education correlated with delayed diagnosis and higher complication rates.

Clinical Presentation Trends

Common clinical presentations in this study included uterine enlargement (55%), hyperemesis (50%), and vaginal bleeding (50%). These classical signs are consistent with the work of Nayak et al. [11] and Strohl and Lurain [15], who noted uterine size and persistent nausea as hallmark features. However, the identification of 35% asymptomatic cases in our series reinforces the growing utility of routine ultrasound in early detection — an approach endorsed by Horowitz et al. [16] in recent clinical guidelines.

Obstetric History and Risk Factor Correlation

In our study, 70% of patients had a history of abortion, and only one had a previous molar pregnancy. Despite this trend, statistical testing revealed no significant association between abortion history and mole type (Fisher’s Exact Test, OR = 2.75, p = 0.586). These findings are consistent with Alimohammadi et al. [9,13], who also found no significant link between prior miscarriage and mole type.

Similarly, Chi-square testing for age group and mole type showed no statistically significant difference (χ² = 1.75, df = 4, p = 0.782), although trends suggested older age was more common among complete mole cases. Nahar [14] and Fatima et al. [10] also observed this age association, though small samples limited statistical power.

Gestational Age at Diagnosis

The mean gestational age at diagnosis was 10.83 weeks for complete moles and 9.92 weeks for partial moles, with no significant difference (Mann–Whitney U = 49.5, p = 0.564). These findings are similar to those from Nayak et al. [11] and Singh et al. [18], who reported detection typically occurring between 9–12 weeks, most often following ultrasound prompted by bleeding or hyperemesis.

Complications and Management Approaches

Hemorrhagic complications were present in 25% of our patients, and 10% required transfusion — both more common in the complete mole group but not statistically significant (Fisher’s Exact Test, p = 1.000 for both comparisons). These results are similar to outcomes in Fatima et al. [10] and Nahar [14], where haemorrhage occurred in 20–30% of cases. Management by suction evacuation was the predominant approach (80%), in line with standard treatment protocols discussed in Horowitz et al. [16] and Strohl and Lurain [15].

Risk Factor Trends and Interpretation

Although low SES, poor nutrition, and abortion history were more common among patients with complete moles, our bivariate analyses did not show statistically significant associations. This aligns with findings in Alimohammadi et al. [13] and Smith [17], who emphasized that these are likely multifactorial patterns requiring larger, multivariate models to detect causal associations. Our results support the need for expanded screening in vulnerable groups.

Molar pregnancy remains an important clinical condition in resource-limited settings, with higher incidence among women of low socioeconomic status and limited education. While classical symptoms remain common, a notable proportion of cases were asymptomatic. Early ultrasonography and targeted risk-based surveillance are essential to improving maternal outcomes.

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