Abstract
Objective
To examine the proportion of high-sensitivity urine pregnancy test (HSPT) results
that were positive by time after successful medication abortion.
Study design
We used data from an ongoing study that provides mifepristone and misoprostol for
medication abortion by direct-to-patient telemedicine and mail. Providers evaluated
abortion outcomes by patient interview and clinical tests per clinical judgment and
participant preference. We identified all participants enrolled July 2016 to September,
2020 who had an HSPT result and no indication of viable pregnancy after treatment.
We used logistic regression to examine the association between the timing of the initial
post-treatment HSPT, gestational age, and the proportion of HSPTs that gave a positive
result.
Results
Of the 472 participants in our analysis, 88 (19%) had positive initial HSPTs. The
proportions that were positive at ≤20 days, 21 to 27 days, 28 to 34 days, and ≥35
days after mifepristone ingestion was 14 of 29 (48%), 15 of 58 (26%), 49 of 258 (19%),
and 10 of 127 (8%), respectively (p < 0.001). Gestational age at mifepristone ingestion was not significantly related to
positive HSPT results (p = 0.28). Multivariable logistic regression confirmed both findings and did not identify
a statistically significant interaction between these variables. In the 67 participants
who relied solely on further HSPTs to confirm abortion outcome, the median interval
between the initial positive test and first negative test was 14 days.
Conclusions
The proportion of participants with positive HSPTs declined with time after successful
medication abortion. However, nearly one-fifth of participants with complete abortion
had positive tests 4 weeks after treatment.
Implications
HSPTs provide an inexpensive, convenient option for confirming success of medication
abortion at home. However, a substantial minority of patients without ongoing pregnancy
have positive HSPT results. Development of a symptom-based strategy for medication
abortion outcome assessment without any confirmatory tests should be a priority.
Keywords
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Article info
Publication history
Published online: February 14, 2021
Accepted:
February 9,
2021
Received in revised form:
February 9,
2021
Received:
November 13,
2020
Footnotes
Declarations of interest: Bliss Kaneshiro received research salary support through an institutional grant from Estetra Pharmaceuticals, Sebela Pharmaceuticals, and Merck, Sharpe, Dohme.
Financial support: This work was supported by the Tara Health Foundation, the Hopewell Fund, and two anonymous donors. These donors had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
Identification
Copyright
© 2021 Published by Elsevier Inc.
