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Classification of Gestational Trophoblastic Disease (GTD): A Critical Review

K. F. Tham
S. S. Ratnam (Professor & Head)

Department of Obstetrics and Gynaecoloy,
National University Hospital,
Singapore Lower Kent Ridge,
Singapore

Summary

• A staging system similar to that for other cancers does not apply, because in most cases diagnosis is based on clinical or biochemical parameters, not histology.
  
  
• Two broad categories of classification are currently in use. One is based on the usual staging system for cancers (with four stages), but incorporating prognostic factors. The other consists of risk tables based on anatomic spread as well as prognostic factors.
  
  
• The ideal classification system would have four stages of disease, so that comparison is easier, with recommendations for combination chemotherapy beyond certain stages.

Note

This article has been updated and developed from the one originally published in Int J Gynaecol Obstet 1998;60(Suppl.1): S39-49, and modified to suit the style of the Journal.

Non-surgical Management of Ectopic Pregnancy

Suneeta Mittal (Professor)

Department of Obstetrics and Gynaecology
All India Institute of Medical Sciences (AIIMS),
New Delhi 110029, India.

Summary

• Advances in diagnostic and monitoring facilities have enabled the emergence of several non-surgical (medical) methods for managing ectopic pregnancy.
  
  

• The techniques (expectant management, systemic and local medical therapy, transcervical tubal cannulation/drug instillation) have been evaluated in clinical studies and the results are positive.
  
  

• Medical management compares well with conservative (laparoscopic) surgery and is especially useful in cases of persistent trophoblastic disease, cornual and cervical pregnancy.
  
  

• Medical management is a viable option for early unruptured ectopic gestation, with surgery being reserved for emergencies and neglected presentations.

Editor's Comment

A revolutionary change has taken place in the management of ectopic pregnancy, as several non-surgical options have come to the fore. In this article, Professor Mittal reviews the current state of knowledge regarding the medical and expectant management of early unruptured ectopic gestation. Also included is an erudite discussion on such controversial issues as medical management versus conservative surgery.

Extraperitoneal Caesarean Section: The Salem Polyclinic Experience

Rashmi Rao
Padma Rao
Anupama Rohidekar

Department of Obstectrics and Gynaecology,
Salem Polyclinic,
Salem,
India

Summary

• EPCS was undertaken in 3628 patients over a 10-year period.
  
  

• The procedure involved creating a uterovesical space by separating the loose areolar tissue between the bladder and uterus and exposing the bare lower uterine segment.
  
  

• The incidence of general peritonitis and paralytic ileus was nil; the incidence of bladder injury was insignificiant.
  
  

• Patients were allowed oral intake of solids and were ambulant soon after recovery from anaesthesia.

Editor's Comment

Though in developed countries, EPCS may be considered an obsolete procedure, its importance in India, a poor and predominantly rural country with limited antenatal and perinatal facilities, needs to be emphasised. The quick recovery afforded by this surgery also enables women to become ambulatory and perform their daily chores again promptly.

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