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Poor Compliance With Postmolar Surveillance and Treatment Protocols by Indigent Women

From the Division of Gynecologic Oncology, the Department of Obstetrics and Gynecology, and the Department of Pathology, Cook County Hospital, Chicago, Illinois.

Address reprint requests to: L. Stewart Massad, MD, Department of Obstetrics and Gynecology, Cook County Hospital, 1835 West Harrison Street, Chicago, IL 60612, E-mail: ismassad{at}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 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.

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