Background Gestational trophoblastic disease (GTD) is a histological diagnosis with risk of persistent trophoblastic neoplasia and choriocarcinoma. Centralised registration process in UK enables adherence to strict follow up protocol in our unit.
Aims To evaluate and improve management of women with GTD at our unit.
Methodology Review of cases over five year period 2007-2011 (N=39).
Results 58% presented with vaginal bleeding while others were incidental diagnosis on histology after termination or miscarriage or on scan. 70% were managed by surgical evacuation. 51% were suspected at scan and concordance between scan and histological diagnosis was 100%.
100% received documented counselling (86% in 2006). 70% were counselled regarding results within 4 weeks of histology report. 80% received documented future pregnancy avoidance advice until follow up is completed. 77% received advice regarding COC pill and 13% regarding IUCD coil.
Conclusions and recommendations Overall good standard of diagnosis and management of GTD at our unit was highlighted through this besides an excellent level of concordance between scan and histological diagnosis. Improvement was noted in women counselled after diagnosis (84% vs 100%) and in scan diagnostic accuracy (34% vs 51% with 100% concordance with histology). There is room for improvement in quality of documentation standard. A systematic structured process of documentation has been implemented since and work is in progress with design of a unit specific information leaflet as decision aid for women to choose management options when GTD is suspected besides revision to guidelines.
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