Gestational trophoblastic disease: experience at a tertiary care hospital of Peshawar

To find out the frequency, clinical presentation, type, extent and treatment modalities of Gestational trophoblastic disease. This was a descriptive study of 45 patient with Gestational trophoblastic disease admitted in Gynae "B" unit of Lady Reading Hospital over a period of one year from first of August 1992 to thirty first July 1993. The case records of all these patients were analyzed regarding their clinical presentation, investigation, treatment and follow up. The frequency of Gestational trophoblastic disease was 11.8/1000 pregnancies or 17.6/1000 deliveries. Out of 45 cases of Gestational trophoblastic disease, 38 were hydatidiform mole [H. Mole] and 7 were choriocarcinoma. The commonest age group was 21-39 yrs [68.5%]. The disease was common in multigravida and grand multigravida [44%-40%]. Variable period of amenorrhea associated with vaginal bleeding was the main presenting symptom [99.5%]. Seventy three percent [73.3%] of patient had suction evacuation. Eighty percent [80%] of the patient did come for follow up. One patient died in case of choriocarcinoma due to complication. Frequency of trophoblastic disease was high in this study compared to world and national literature. Regular follow up and counseling is essential to decrease the mortality and morbidity from this condition

Impact of external cephalic version [ECV] on mode of delivery of the term singleton breech

To assess the impact of external cephalic version [ECV] on the mode of delivery of the uncomplicated term, singleton breech at teaching hospital. This observational study was conducted in Obstetrics and Gynecology department, Hayatabad Medical Complex, Peshawar from 1st December 2003 to 31st January 2005 on all singleton term breech presentations from 37 to 41 weeks of gestation. Out of 265 women presenting with breech presentation at 37 completed weeks or more at our unit during the study period, 188 patients met the selection criteria. Of these only 40 patients [21.3%] had ECV. Twenty seven of these were successful [67%]. A total of 161 patients continued their pregnancies as breech. Of these the mode of the delivery was: Vaginal Breech Delivery in 97 cases [60.24%] and CSection in 64 [39.76%]. Reasons for failure to offer ECV included; 129 [80.12%] cases were unbooked and admitted in emergency when ECV services were not available. 145 [90%] were admitted in labour, and majority of these were in active and advanced labour. ECV was not found to decrease significantly the number of non-cephalic presentation at term. The reasons were that in spite of good success rates it was not feasible to perform enough ECV to have an impact on mode of delivery of singleton term breeches