To prospectively describe the decline in serum human chorionic gonadotropin (hCG) in the first 5 days after complete medical abortion and evaluate the influence of initial hCG and gestational duration.
We conducted a prospective, physiologic study of women ≤63 days gestation who underwent medical abortion with 200 mg mifepristone and 800 mcg buccal misoprostol. We stratified enrollment into two gestational cohorts, <49 days and 49–63 days, to ensure gestational variability. We collected serum quantitative hCG values on Day 1 (day of mifepristone), Day 3, Day 5 and a routine follow up hCG on Days 7–14. We calculated the percent hCG decline from Day 1 to each repeat measure and evaluated trends based on initial serum hCG level and gestation.
We enrolled 66 women; 59 were protocol-adherent and included in our analysis. Mean gestation on Day 1 was 49 days and mean baseline hCG was 72,332 IU. Fifty-seven subjects (97%) had a complete medical abortion without further intervention. The mean serum hCG decline among subjects with complete medical abortion was 70.0±10.6% [range 36.9–98.6%] on Day 3 and 91.4±4.4% [range 68.4–97.7%] on Day 5. The mean serum hCG decline from Day 1 to routine follow-up on Days 7–9 was 97.1±1.7% [range 92.4–99.2%], from Day 1 to Day 10–11 was 98.5±1.4% [range 94.7–99.6%] and from Day 1 to Day 12–14 was 98.7±2.8% [range 86.7–99.9%]. There was no difference in percent hCG decline stratified by initial hCG or gestation.
There is a rapid and predictable decline in serum hCG as early as Day 5 after complete medical abortion through 63 days gestation. Rate of hCG decline is not affected by initial hCG or gestational duration.
For women who require confirmation of complete abortion sooner than 1 week after mifepristone, due to patient preference, logistical constraints or in the setting of pregnancy of unconfirmed location, a single repeat hCG on Day 5 may be clinically useful.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Contraception
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Abortion incidence and service availability in the United States, 2011.Perspect Sex Reprod Health. 2014; 46: 3-14
- Mifepristone with buccal misoprostol for medical abortion: a systemic review.Obstet Gynecol. 2015; 126: 12-21
- Mifiprex® [package insert].Danko Labratories, LLC, New York, NY2016
- Can women accurately assess the outcome of medical abortion based on symptoms alone?.Contraception. 2012; 85: 192-197
- Acceptability and feasibility of phone follow-up after early medical abortion in Vietnam.Obstet Gynecol. 2014; 123: 88-95
- ACOG practice bulletin no. 143: medical management of first-trimester abortion.Obstet Gynecol. 2014; 123: 676-692
- Clinical policy guidelines.National Abortion Federation, Wastington, DC2015
- The Care of Women Requesting Induced Abortion: evidence-based clinical guideline no.7.Royal College of Obstetricians and Gynaecologists, London, UK2011
- Verifying the effectiveness of medical abortion; ultrasound versus hCG testing.Eur J Obstet Gynecol Reprod Biol. 2003; 109: 190-195
- Alternatives to a routine follow-up visit for early medical abortion.Obstet Gynecol. 2010; 115: 264-272
- Feasibility of telephone follow-up after medical abortion.Contraception. 2010; 81: 143-149
- Alternatives to ultrasound for follow-up after medication abortion: a systematic review.Contraception. 2011; 83: 504-510
- Can at-home semi-quantitative pregnancy tests serve as a replacement for clinical follow-up of medical abortion? A US study.Contraception. 2012; 86: 757-762
- Simplified follow-up after early medical abortion: 12-month experience of a telephone call and self-performed low-sensitivity urine pregnancy test.Contraception. 2014; 89: 440-445
- Monitoring serum chorionic gonadotropin levels after mifepristone abortion.Contraception. 2001; 64: 271-273
- The kinetics of serum hCG and progesterone in response to oral and vaginal administration of misoprostol during medical termination of early pregnancy.Hum Reprod. 2002; 17: 2315-2319
- Early serum human chorionic gonadotropin (hCG) trends after medication abortion.Contraception. 2015; 91: 503-506
Published online: September 09, 2016
Accepted: September 5, 2016
Received in revised form: September 2, 2016
Received: March 1, 2016
☆Funding: Society of Family Planning Research Fund
★Clinical trial registration number: NCT02179944
★★The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America, Inc.
© 2016 Elsevier Inc. All rights reserved.