Abstract
Objectives
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.
Study design
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.
Results
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.
Conclusions
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.
Implications
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.
Keywords
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Article info
Publication history
Published online: September 09, 2016
Accepted:
September 5,
2016
Received in revised form:
September 2,
2016
Received:
March 1,
2016
Footnotes
☆Funding: Society of Family Planning Research Fund
☆☆Disclosures: none
★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.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
