Simplified follow-up after early medical abortion: 12-month experience of a telephone call and self-performed low-sensitivity urine pregnancy test

Comparing office and telephone follow-up after medical abortion

“…This finding may be attributed to women being able to choose their preferred method of follow-up. Previous studies report lost to follow-up rates as high as 18-45% when office follow-up is the only option [3,12] and 13-30% in retrospective studies of telephone assessment with UPT [6][7][8]. Given the high efficacy of medical abortion and low rates of ongoing pregnancy, recent studies have also evaluated medical abortion outcomes with a self-assessment and low-sensitivity UPT [13] or semi-quantitative UPT [14].…”

“…Alternatively, telephone follow-up with a home UPT eliminates an in-person visit. Studies have evaluated regimens utilizing telephone evaluation and high-sensitivity UPT [5,6], low-sensitivity UPT [7,8], and semi-quantitative UPT [9,10], and all appear effective in detecting ongoing pregnancies. In the United States, the high-sensitivity UPT is commercially available and can be integrated into clinical practice.…”

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

“…Although ongoing pregnancy occurs <1% of the time with mifepristone and misoprostol ≤10 weeks of gestation, there is ongoing investigation into how best to identify these women, whether it be symptom‐based or by use of semi‐quantitative4, 31, 32 or low‐sensitivity2, 3 urine pregnancy tests. The critical step for safely self‐using medical termination is understanding when to seek medical care, both for signs and symptoms of ongoing pregnancy as well as for complications such as bleeding and infection, and documenting that they are able to do so.…”

“…Administration of the misoprostol and pregnancy expulsion usually take place outside a health facility and women manage the termination process at home, similar to experiencing a spontaneous termination of pregnancy. Confirming that early termination is successful has traditionally taken place in a health facility 1–2 weeks later and is based on history and physical examination and, if needed, ultrasound or laboratory testing 2, 3. Although home use of semi‐quantitative or low‐sensitivity urine pregnancy tests has also been shown to be effective in research studies to detect a rare ongoing pregnancy, they are not universally available 2, 3, 4.…”

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

“…8 Alternative out-of-clinic strategies involving providers have included a standardized telephone questionnaire between provider and woman, 13 or a telephone consultation plus a urine pregnancy test − high sensitivity at 30 days 14 or low sensitivity at 14 days. 15,16 Web-based approaches have used an email consultation or an online form. 17,18 Studies exploring safe self-assessment methods have included a set of questions on the symptoms experienced plus different pregnancy tests.…”