Massad L S, Abu-Rustum N R, Lee S S, Renta V
Division of Gynecologic Oncology, the Department of Obstetrics and Gynecology, Cook County Hospital, Chicago, Illinois 60612, USA.
Obstet Gynecol. 2000 Dec;96(6):940-4. doi: 10.1016/s0029-7844(00)01064-4.
To estimate compliance by indigent women with surveillance protocols after molar pregnancy.
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.
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).
Most indigent women failed to comply with postmolar surveillance, although most achieved remission. Injectable medroxyprogesterone acetate is recommended for postmolar contraception in this population.
评估贫困妇女葡萄胎妊娠后对监测方案的依从性。
在一家城市公立医院接受葡萄胎清宫术的妇女被建议每周复诊，直至人绒毛膜促性腺激素（hCG）水平降至5 mIU/mL以下，之后每月复诊6个月；或直至诊断并治疗妊娠滋养细胞疾病，之后每月复诊12个月。采用酶联免疫吸附测定法进行激素检测。采用卡方检验进行统计学分析。
在确定的51名妇女中，11名（22%）发生了滋养细胞疾病。所有患者化疗后均获缓解。这11名患者中有5名（45%）至少错过一次治疗，7名（64%）至少错过一次缓解后复诊，且无人完全遵守方案。其余40名妇女中有5名（13%）在缓解前失访。未接受化疗的40名妇女中有7名（18%）完全遵守方案，5名（13%）在缓解前失访，16名（40%）在完成6个月随访前失访。51名妇女中只有15名（29%）在无妊娠滋养细胞疾病或妊娠的情况下完成了监测。6名妇女怀孕，注射用醋酸甲羟孕酮的妊娠率较低（25名中的0名，而26名中的6名（23%），P<.01）。
大多数贫困妇女未遵守葡萄胎妊娠后的监测，尽管大多数患者获得了缓解。建议在该人群中使用注射用醋酸甲羟孕酮进行葡萄胎妊娠后的避孕。
