Poor compliance with postmolar surveillance and treatment protocols by indigent women

L. Stewart Massad, Nadeem R. Abu-Rustum, Suzette S. Lee, Vivian Renta

Research output: Contribution to journalArticle

39 Scopus citations

Abstract

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 χ2 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. (C) 2000 by The American College of Obstetricians and Gynecologists.

Original languageEnglish
Pages (from-to)940-944
Number of pages5
JournalObstetrics and gynecology
Volume96
Issue number6
DOIs
StatePublished - Nov 27 2000
Externally publishedYes

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