title: Management of gestational trophoblastic disease: a survey of New Zealand O&G practice.
abstract: OBJECTIVE
  The aim of the study was to obtain information on pathways for diagnosis and management of molar pregnancy/gestational trophoblastic disease (GTD) across New Zealand, the protocols used, and, in addition, to consider the view of O&G Specialists on a national GTD reference centre.
  
  
  METHODS
  An electronic survey approved by the RANZCOG Continues Professional Development Committee was distributed amongst registered O&G Specialists currently working in New Zealand. Data were analysed using Microsoft Excel 2011. Frequency distributions were used to determine the percentage of participants responding to the listed alternatives for each question.
  
  
  RESULTS
  There were 234 potential responders, but only 68 complete questionnaires were received and available for analysis. The diagnosis of GTD requires histopathological analysis of pregnancy tissue, however only 79.7% of participants request this test routinely. Sixty-five percent of Fellows thought that a number of molar pregnancies can be missed with increasing proportion of medically-managed miscarriages, reliance on ultrasound and appearance of the tissue being contributing factors. Sixty-six percent of specialists were directly involved in the management of patients with GTD to various degrees. Follow-up responsibilities were divided between designated O&G specialists (52.3%), specialised gynaecology clinics (29.2%), acute assessment units (13.8%), nurse specialists (12%), O&G registrars (10.8%), GPs (6.2%), and others (6.2%). NZGCG guidelines were used by the majority of responders (54.8%), followed by local (29%) and RCOG (27.4%) guidelines. Seventy-two percent of specialists felt that some form of centralisation in the management of GTD is needed.
  
  
  CONCLUSIONS
  In spite of the low response rate, our research demonstrates existing practice heterogeneity at every level of care. It also confirms that there is a desire for some form of centralisation in diagnosis and management of GTD, and a definite need for data collection in the form of a national register.
authors.affiliation: Department of O&G, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia. mkladnitski@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Kladnitski
authors.forename: Diane
authors.initials: D
authors.lastname: Kenwright
mesh_terms: D002822:Choriocarcinoma / Q000175:diagnosis / Q000628:therapy; D019468:Disease Management; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000175:diagnosis / Q000628:therapy; D019983:Guideline Adherence; D006176:Gynecology; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis / Q000628:therapy*; D009520:New Zealand; D009774:Obstetrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011795:Surveys and Questionnaires; D018245:Trophoblastic Tumor, Placental Site / Q000175:diagnosis / Q000628:therapy*; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000628:therapy*