Simplified follow-up after early medical abortion: 12-month experience of a telephone call and self-performed low-sensitivity urine pregnancy test

Abstract

ObjectiveThe objective was to determine if simplified follow-up after early medical abortion, consisting of a telephone call 2 weeks after the procedure plus a self-performed low-sensitivity urine pregnancy (LSUP) test, was successful for screening for ongoing pregnancies in the year following its introduction as standard service. Study designA retrospective computerized database review of 1084 women at a hospital abortion service in Edinburgh, UK, who had a medical abortion (≤9 weeks) and went home to expel the pregnancy was performed. Women who screened ‘positive’ at telephone follow-up on the basis of ongoing pregnancy symptoms, scant bleeding or LSUP test result were scheduled for an ultrasound. The main outcome measures were the proportion of women scheduled for telephone follow-up successfully contacted and the proportion of ongoing pregnancies detected. ResultsA total of 943 women were scheduled for telephone follow-up. Ten women presented to the hospital before the time of the follow-up call. Of the remaining 933 women, 656 [70%, 95% confidence interval (CI) 67.7-73.2] were successfully contacted. Five hundred seventy-three (87%, 95% CI 84.5–89.7) of those contacted screened ‘negative’; no false negatives occurred. Eighty-three (13%, 95% CI 10.2–15.5) screened ‘positive,’ and of those, three had ongoing pregnancies. Of the 277 (30%, 95% CI 26.7–32.7) who were not contacted, two ongoing pregnancies occurred. The sensitivity of telephone follow-up with LSUP to detect ongoing pregnancy was 100% (95% CI 30.9%–100%), and specificity was 88% (95% CI 84.9%–90.1%). The negative predictive value was 100% (95% CI 99.1%–100%), and positive predictive value was 3.6% (95% CI 0.9%–10.9%). ConclusionA telephone call and LSUP test at 2 weeks are suitable as a standard method of follow-up for screening for ongoing pregnancy after early medical abortion. Implications statementFor most women, a routine clinic follow-up after early medical abortion (to exclude ongoing pregnancy) can be replaced with a telephone call and a self-performed LSUP test at 2 weeks postprocedure.