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Telemedicine in post-molar follow-up: is it a useful tool?
  1. Rafaela Tessaro de Assis1,
  2. Luiza Russo de Morais1,
  3. Ana Carolina Ferreira Simões de Freitas1,
  4. Roney Cesar Signorini FIlho1,
  5. Lucas Ribeiro Borges de Carvalho1,
  6. Bruna Elias Parreira1,
  7. Cíntia Yurie Yamachi2,
  8. Antonio Braga3 and
  9. Sue Yazaki Sun1
  1. 1 Department of Obstetrics, Universidade Federal de São Paulo, Sao Paulo, Brazil
  2. 2 UNIFESP, Sao Paulo, São Paulo, Brazil
  3. 3 Department of Obstetrics and Gynecology, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
  1. Correspondence to Dr Luiza Russo de Morais, Department of Obstetrics, Universidade Federal de São Paulo, Sao Paulo, Brazil; luiza.morais{at}huhsp.org.br

Abstract

Background Telemonitoring is an alternative to in-person appointments and overcomes geographic distance barriers.

Objective The primary objective of this study was to evaluate adherence to post-molar follow-up using both WhatsApp and in-person appointments compared with standard care. The secondary objective was to evaluate the rate of completion of post-molar follow-up of complete moles, considering 6 and 3 months of duration.

Methods This retrospective cohort study was conducted at the Gestational Trophoblastic Disease Center, São Paulo Hospital. Patients with complete or partial mole treatment between January 1, 2009 and December 31, 2018 were included in two groups: group 1 (patients from 2009 to 2013) and group 2 (from 2014 to 2018), before and after telemonitoring implementation, respectively. Complete follow-up was considered if after the first normal human chorionic gonadotropin (hCG) level (<5 mIU/mL), the patient was followed up for an additional 30 days (partial mole) or 180 days (complete mole). Loss to post-molar follow-up with positive hCG was also evaluated. Statistical analysis was performed using Pearson’s Χ2 test, 5% significance level (p=0.05), and R version 4.0.2.

Results A total of 308 patients were included in the study, 92 of them were assessed in group 1 and 216 patients in group 2. There was no difference between the rates of complete follow-up after telemonitoring implementation (complete mole: 42/72=58.3% group 1 vs 85/163=52.1% group 2; p=0.38; partial mole: 16/20=80% group 1 vs 37/53=69.8 group 2; p=0.3), and no increase of loss to post-molar follow-up with positive hCG (8/92=8.7% group 1 vs 14/216=6.5% group 2; p=0.49). The shortening of follow-up of complete moles to 90 days increased the rate of complete post-molar follow-up (from 127/235=54.0% to 189/235=80.4%, p<0.001).

Conclusions The association of telemonitoring with in-person appointments could have had an advantage in post-molar follow-up since it did not reduce adherence to hormonal surveillance. Shortening post-molar follow-up after complete mole to 90 days after the first normal hCG level increased the rate of complete post-molar follow-up.

  • Gestational Trophoblastic Disease
  • Hydatidiform Mole
  • Pregnancy Complications, Neoplastic
  • Trophoblastic Neoplasms

Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors RTdA: guarantor that developed the idea, collected data from medical records, analyzed data, and wrote the original manuscript. LRdM: analyzed data, reviewed data, and also wrote this manuscript. ACFSdF, RCSF, LRBdC, BEP, CYY, AB: reviewed carefully all the data and results to avoid errors, followed by afinal review of this manuscript. SYS: developed the idea, provided data from medical records, analyzed data after collection, and wrote the final manuscript.

  • Funding RTdA received a fellowship for the development of the study from “Conselho Nacional de Desenvolvimento Científico e Tecnológico”.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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