Abstract
Objective
The objective was to summarize data on the accuracy and acceptability of a strategy
for identifying ongoing pregnancy after medical abortion treatment using a low-sensitivity
pregnancy test (LSPT).
Study design
We searched PubMed to identify studies that evaluated the use of a single posttreatment
LSPT for detection of ongoing pregnancy after treatment with mifepristone and misoprostol.
We extracted, assessed and summarized data from each study.
Results
We found 10 studies that evaluated 6 LSPTs with human chorionic gonadotropin detection
thresholds of 1000, 1500 or 2000 mIU/mL. The three earliest studies compared the pregnancy
test strategy to standard assessment in the same women; the sensitivity of a positive
or invalid LSPT result for detecting ongoing pregnancy ranged from 67% to 100%. Three
randomized trials found no significant difference in detection of ongoing pregnancy
between the LSPT strategy and routine in-person follow-up. Four noncomparative studies
found that of the 12 women who had ongoing pregnancies diagnosed after performing
an LSPT, 8 (67%) had positive or invalid LSPT results. Across the 10 studies, 30 of
the 59 total ongoing pregnancies (51%) were identified based on symptoms without a
positive or invalid LSPT result. Women expressed satisfaction with the LSPT strategy.
Risk of bias in the seven later studies was high.
Conclusions
Despite their limitations, most studies showed that the LSPT strategy had moderate
sensitivity for identifying ongoing pregnancy and can enable the majority of medical
abortion patients to assess treatment outcome at home. However, the LSPT itself had
a limited role in the detection of treatment failures in the studies.
Implications statement
The LSPT strategy shows promise for reducing the need for in-person follow-up after
medical abortion. A range of home-based options should be validated to meet the varied
needs of women and abortion providers in diverse settings.
Keywords
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Article info
Publication history
Published online: March 10, 2018
Accepted:
March 7,
2018
Received:
September 18,
2017
Footnotes
☆Disclosure of interests: Authors report no conflicts of interest.
☆☆Funding: This research was funded by an anonymous charitable donor.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
