Abstract
Objective
To determine the outcome of early medical termination of pregnancy (TOP) among women
who choose a “self assessment” follow up comprising a self-performed low sensitivity
urine pregnancy test with instructions on signs/symptoms that mandate contacting the
TOP service.
Study design
A retrospective review of computer databases of 1726 women choosing self-assessment
after early medical TOP (<9 weeks) in the UK. The main outcome measures were (a) number of women choosing self-assessment,
(b) contact rates with TOP service and (c) time to presentation with an ongoing pregnancy
(failed TOP).
Results
Ninety-six percent of women having an early medical TOP and going home to expel the
pregnancy chose self-assessment. Two percent of women made unscheduled visits to the
TOP service. One hundred and eighty-eight women (11%) telephoned the service about
concerns related to complications or the success of treatment. There were eight ongoing
pregnancies (0.5%; 95% confidence interval 0.2–0.9%). Four were detected within 4
weeks of treatment; the remainder were not detected until one or more missed menses
after the procedure.
Conclusions
Most women having an early medical TOP, who go home to expel the pregnancy, choose
self-assessment. Relatively few women make unscheduled visits or telephone the TOP
service. Most ongoing pregnancies are recognized at an early stage, although late
presentation (as with all methods of follow up) does still occur.
Implications statement
If women are given clear instructions on how and when to conduct a urine pregnancy
test and on signs/symptoms that mandate contacting the TOP service, then they can
confirm the success of early medical TOP themselves. Late presentation due to failure
to recognize an ongoing pregnancy is rare.
Keywords
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References
- Induced abortion: incidence and trends worldwide from 1995 to 2008.Lancet. 2012; 379: 625-632
- Abortion Statistics, England and Wales: 2013.([access date 24 June 2014])
- Abortion Statistics 2013 May 2014.([access date 12 September 2014])
- The care of women requesting induced abortion. Guideline number 7. 2011.([access date 12 September 2014])
- Safe abortion: technical and policy guidance for health systems.2nd ed. 2012 ([http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf (access date 14 March 2014)])
- Comparison of unscheduled re-attendance and contraception at discharge, amongst women having the final stage of early medical abortion at home and those remaining in hospital.J Fam Plann Reprod Health Care. 2012; 38: 35-40
- Women’s experiences of the final stage of early medical abortion at home: results of a pilot survey.J Fam Plan Reprod Health Care. 2010; 36: 213-216
- Endometrial thickness following medical abortion is not predictive of subsequent surgical intervention.Ultrasound Obstet Gynecol. 2009; 34: 104-109
- Role of routine ultrasonography in monitoring the outcome of medical abortion in a clinical setting.Acta Obstet Gynecol Scand. 2004; 83: 390-394
- Alternatives to ultrasound for follow-up after medication abortion: a systematic review.Contraception. 2011; 83: 504-510
- Telephone follow-up and self-performed urine pregnancy testing after early medical abortion: a service evaluation.Contraception. 2012; 86: 67-73
- Simplified follow-up after early medical abortion: 12 months experience of a telephone call and self-performed low sensitivity urine pregnancy test.Contraception. 2014; 89: 440-445
- Follow up after abortion.in: Rowlands Abortion care, chapter 12. 9781107647381 Cambridge Press, 2014: 106-113
- Effect of contraception provided at termination of pregnancy and incidence of subsequent termination of pregnancy.BJOG. 2012; 119: 1074-1080
- Carstairs scores for Scottish postcode sectors from the 2001 census– report.([12 September 2014])
- Eliminating the routine postoperative surgical visit.Contraception. 2012; 86: 397-401
- Benefits of using a digital video disk for providing information about abortion to women requesting termination of pregnancy.Contraception. 2010; 81: 537-541
- Alternatives to routine ultrasound for eligibility assessment prior to early termination of pregnancy with mifepristone-misoprostol.BJOG. 2011; 118: 17-23
- Can midlevel health-care providers administer early medical abortion as safely and effectively as doctors? A randomised controlled equivalence trial in Nepal.Lancet. 2011; 377: 1155-1161
- The efficacy, safety and acceptability of medical termination of pregnancy provided by standard care by physicians or by nurse-midwives - a randomized controlled equivalence trial.BJOG. 2014; https://doi.org/10.1111/1471-0528.12982
- UR OK? The acceptability and feasability of remote technologies for follow up after early medical abortion.Contraception. 2014; 9: 29-35
Article info
Publication history
Published online: September 18, 2014
Accepted:
September 13,
2014
Received in revised form:
September 12,
2014
Received:
July 2,
2014
Footnotes
☆Conflict of interests: STC is member of the European scientific advisory board to Exelgyn. AG is a scientific advisor to HRA Pharma.
☆☆Details of ethics/IRB approval: Not required.
★Funding: The work was undertaken with support of the Scottish Department of Sexual Health and blood Borne viruses, as part of a series of initiatives aimed at improving the patient journey through TOP.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
