Feasibility of telephone follow-up after medical abortion

Perriera, Lisa K.; Reeves, Matthew F.; Chen, Beatrice A.; Hohmann, Heather L.; Hayes, Jennifer; Creinin, Mitchell D.

doi:10.1016/j.contraception.2009.08.008

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Volume 81, Issue 2 , Pages 143-149, February 2010

Feasibility of telephone follow-up after medical abortion☆

Lisa K. Perriera
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA 15213, USA
- Corresponding author. Case Western Reserve University School of Medicine, Department of Obstetrics and Gynecology, University Hospitals, MacDonald Women's Hospital 11100 Euclid Ave. Cleveland OH 44106, USA. Tel.: +1 216 844 3888; fax: +1 216 844 3348.
Matthew F. Reeves
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA 15213, USA
- Magee-Womens Research Institute, Pittsburgh, PA 15213, USA
Beatrice A. Chen
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA 15213, USA
Heather L. Hohmann
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA 15213, USA
Jennifer Hayes
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA 15213, USA
Mitchell D. Creinin
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA 15213, USA
- Magee-Womens Research Institute, Pittsburgh, PA 15213, USA
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA 15261, USA

Received 20 June 2009; received in revised form 24 August 2009; accepted 25 August 2009. published online 05 October 2009.

Abstract

Background

This study was conducted to assess the feasibility of using telephone calls combined with high-sensitivity urine pregnancy testing as a primary method of follow-up after medical abortion.

Methods

We enrolled 139 women up to 63 days of gestation to receive mifepristone 200 mg orally and misoprostol 800 mcg vaginally or buccally, per their choice. Participants were contacted by phone one week after mifepristone administration and interviewed using standardized questions. If the subject or clinician thought the pregnancy was not expelled, the subject returned for an ultrasound examination. Otherwise, subjects performed high-sensitivity home urine pregnancy testing 30 days after the mifepristone and were called within 3 days of the test. Those with positive pregnancy tests returned for an ultrasound examination. Those with negative tests required no further follow-up.

Results

Six of the 139 (4.3%, 95% CI 1.6–9.1%) subjects presented prior to Phone Call 1 for an in-person visit. All 133 (100%, 95% CI 97.8–100%) subjects eligible for their first telephone follow-up were contacted. Eight of the 133 (6.1%, 95% CI 2.6–11.5%) women were asked to return for evaluation and all did so (100%, 95% CI 63.1–100%). Eight of the 133 women eligible for the 30 day phone call presented for an interim visit prior to the call. After 30 days, 116 of the 117 (99.1%, 95% CI 97.5–100%) eligible subjects were contacted. One subject was not reached for the day 30 phone call. Twenty-seven of the 116 (23.3%, 95% CI 15.6–31.0%) subjects had a positive pregnancy test and required follow-up. Two of these subjects (7.4%, 95% CI 1.0–24.2%) did not return for in-person follow-up. Two of the 116 (1.7%, 95% CI 0.2–6.1%) subjects had inconclusive pregnancy tests and were asked to return for follow-up. One of these subjects (50%, 95% CI 1.2–98.7%) did not return. Complete follow-up was achieved in 135 of the 139 subjects (97.1%, 95% CI 94.3–99.9%). None of the 26 women evaluated for a positive or inconclusive pregnancy test had a gestational sac or continuing pregnancy.

Conclusion

Telephone follow-up combined with urine pregnancy testing after medical abortion is a feasible alternative to routine ultrasonography or serial serum hCG measurements.

Keywords: Medical abortion, Telephone follow-up, Urine pregnancy test, Mifepristone, Misoprostol