Poor compliance with postmolar surveillance and treatment protocols by indigent women

Objective: To estimate compliance by indigent women with surveillance proto cols after molar pregnancy. Methods: Women whose molar pregnancies were evacuated at an urban, public h ospital were advised to return weekly either until hCG levels decreased bel ow 5 mIU/mL, then monthly for 6 months, or until diagnosis and treatment of gestational trophoblastic disease, then monthly for 12 months. Hormone tes ting 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 fi ve (13%) were lost to follow-up before remission, and 16 (40%) were lost be fore completing 6 months of follow-up. Only 15 (29%) of the 51 women comple ted surveillance without gestational trophoblastic disease or pregnancy. Si x women conceived, and injectable medroxyprogesterone acetate was associate d 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 surveillanc e, although most achieved remission. Injectable medroxyprogesterone acetate is recommended for postmolar contraception in this population. (Obstet Gyn ecol 2000;96:940-4. (C) 2000 by The American College of Obstetricians and G ynecologists.).