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

Abstract

Objective: The 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 design: A 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.

Results: A 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%).

Conclusion: A 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 statement: For 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.

Keywords: Medical termination of pregnancy; Postabortal; Telephone follow-up; Termination of pregnancy.