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Poor compliance with postmolar surveillance and treatment protocols by indigent women
L S Massad1, N R Abu-Rustum, S S Lee
1Division of Gynecologic Oncology, the Department of Obstetrics and Gynecology, Cook County Hospital, Chicago, Illinois 60612, USA. ismassad@ameritech.net
Objective:
To estimate compliance by indigent women with surveillance protocols after molar pregnancy.
Methods:
Women whose molar pregnancies were evacuated at an urban, public hospital were advised to return weekly either until hCG levels decreased below 5 mIU/mL, then monthly for 6 months, or until diagnosis and treatment of gestational trophoblastic disease, then monthly for 12 months. Hormone testing was by enzyme-linked immunosorbent assay. Statistical analysis was by chi(2) tests.
Results:
Of 51 women identified, 11 (22%) developed trophoblastic disease. All achieved remission after chemotherapy. Five (45%) of these 11 missed at least one treatment, seven (64%) missed at least one postremission visit, and none was fully compliant with protocols. Five (13%) of the 40 remaining women were lost to follow-up before remission. Seven (18%) of the 40 women who did not receive chemotherapy complied fully with protocols, whereas five (13%) were lost to follow-up before remission, and 16 (40%) were lost before completing 6 months of follow-up. Only 15 (29%) of the 51 women completed surveillance without gestational trophoblastic disease or pregnancy. Six women conceived, and injectable medroxyprogesterone acetate was associated with a lower pregnancy rate (zero of 25 compared with six of 26 (23%), P <.01).
Conclusion:
Most indigent women failed to comply with postmolar surveillance, although most achieved remission. Injectable medroxyprogesterone acetate is recommended for postmolar contraception in this population.