Assessment of completion of early medical abortion using a text questionnaire on mobile phones compared to a self-administered paper questionnaire among women attending four clinics, Cape Town, South Africa

Abstract

In-clinic follow-up to assess completion of medical abortion is no longer a requirement according to World Health Organization guidance, provided adequate counselling is given. However, timely recognition of ongoing pregnancy, complications or incomplete abortion, which require treatment, is important. As part of a larger trial, this study aimed to establish whether women having a medical abortion could self-assess whether their abortion was complete using an automated, interactive questionnaire on their mobile phones. All 469 participants received standard abortion care and all returnees filled in a self-assessment on paper at clinic follow-up 2-3 weeks later. The 234 women allocated to receive the phone messages were also asked to do a mobile phone assessment at home ten days post-misoprostol. Completion of the mobile assessment was tracked by computer and all completed assessments, paper and mobile, were compared to providers' assessments at clinic follow-up. Of the 226 women able to access the mobile phone assessment, 176 (78%) completed it; 161 of them (93%) reported it was easy to do so. Neither mobile nor paper self-assessments predicted all cases needing additional treatment at follow-up. Prediction of complete procedures was good; 71% of mobile assessments and 91% of paper assessments were accurate. We conclude that an interactive questionnaire assessing completion of medical abortion on mobile phones is feasible in the South African setting; however, it should be done later than day 10 and combined with an appropriate pregnancy test to accurately detect incomplete procedures.

Self-management of medical abortion: a qualitative evidence synthesis

“…1 We draw on a "medicalization" framework 2,3 to describe the spectrum of approaches to the management of medical abortion ranging from most medicalized to least medicalized. Shifts towards less medicalized care can include: the administration of misoprostol in clinic but the option for women to be discharged to manage the process of expulsion at home; 4,5 the option to selfadminister misoprostol at home after the clinical administration of mifepristone; 6,7 the option to administer both misoprostol and mifepristone at home; and replacing follow-up with remote monitoring/self-assessment of abortion completion, for example via mobile phones, 8 or the independent use of self-assessment cards and pregnancy tests. 9,10 In this review, we focused exclusively on firsttrimester medical abortion.…”

A research agenda for moving early medical pregnancy termination over the counter

“…In some settings, hotlines or text messaging have been introduced and in one recent study, was demonstrated to be useful 39. Women who received texts for support during home misoprostol, after mifepristone administration in clinic, had significant reductions in anxiety and stress during the termination process 39.…”

Is self-assessment of medical abortion using a low-sensitivity pregnancy test combined with a checklist and phone text messages feasible in South African primary healthcare settings? A randomized trial

“…However, published literature indicated that self-assessment of medical abortion based on symptoms alone was not reliable [6, 9, 10], and recently the WHO recommended that self-assessment of medical abortion outcome by women should utilize suitable pregnancy tests and checklists [11]. Multi-level (hCG detection thresholds >25, >100, >500, >2000 and >10,000 milli-international units/mL) and dual-level low-sensitivity pregnancy tests (hCG detection thresholds >5 and >1000 or >2000 milli-international units/mL), supplemented by checklists have shown promising results in the US [12], Europe [4, 13–16] and some low- and middle income countries [3, 6, 17, 18].…”