Abstract
Objectives
To assess whether planning high-sensitivity urine pregnancy tests (HSPT) rather than
facility-based tests for medication abortion follow-up may increase risk of unplanned
clinical visits or procedural completion of the abortion.
Study design
We used data from the TelAbortion Project, a 5-year study assessing the safety and
feasibility of providing mifepristone and misoprostol by telemedicine and mail in
the United States. We categorized participants by whether the pretreatment follow-up
plan included HSPT at home 3–5 weeks after treatment or facility-based tests (ultrasound
or serum human chorionic gonadotropin) within 2 weeks after treatment. We used multivariable
logistic regression to compare likelihood of post-treatment unplanned, abortion-related
clinical visits and procedural intervention in these groups.
Results
Of 1324 patients who planned HSPT follow-up and 576 who planned facility-based tests,
85% and 83%, respectively, provided outcome information. Post-treatment clinical visits
were less frequent in the HSPT group (19%) than in the facility-based test group (79%);
most of the latter were to obtain the planned test. However, unplanned, abortion-related
visits were significantly more common in the HSPT group (adjusted risk difference:
6.5%; p < 0.01). The likelihood of procedural completion did not differ by group. Planned
follow-up test was not associated with delay in procedural completion or detection
of ongoing pregnancy.
Conclusions
Follow-up of medication abortion with home HSPT was associated with fewer post-treatment
clinical visits, modestly more unplanned, abortion-related clinical visits, and no
increase in the risk of procedural interventions or delayed identification or management
of treatment failures. This option is an appropriate follow-up approach after medication
abortion.
Implications
Use of home high-sensitivity pregnancy tests rather than facility-based tests for
outcome assessment after medication abortion is associated with a modest increase
in unplanned clinical visits but does not lead to an increase in procedural interventions
or delays identification and management of treatment failure.
Keywords
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Article info
Publication history
Published online: April 21, 2023
Accepted:
April 19,
2023
Received in revised form:
April 15,
2023
Received:
December 11,
2022
Publication stage
In Press Corrected ProofFootnotes
☆☆Funding: This work was supported by the Tara Health Foundation, the Lisa and Douglas Goldman Fund, the David and Lucile Packard Foundation, and two anonymous donors. 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.
☆Conflicts of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.
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