Alternatives to a Routine Follow-Up Visit for Early Medical Abortion
- 1 February 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 115 (2), 264-272
- https://doi.org/10.1097/aog.0b013e3181c996f3
Abstract
To evaluate the ability of women and their providers to assess abortion outcome without the routine use of ultrasonography.This multicenter trial enrolled 4,484 women seeking medical abortion at 10 clinics in the United States. Women received the standard medical abortion care with mifepristone-misoprostol in those clinics and blinded clinical assessments before follow-up ultrasonography. Data were collected prospectively on abortion outcomes, receipt of additional treatment, and clinical, laboratory, and ultrasound assessments associated with the procedure. We constructed five model algorithms for evaluating women's postabortion status, each using a different assortment of data. Four of the algorithms (algorithms 1-4) rely on data collected by the woman and on the results of the low-sensitivity pregnancy test. Algorithm 5 relies on the woman's assessment, the results of the pregnancy test, and follow-up physician assessment (sometimes including bimanual or speculum examination).A total of 3,054 women received medical abortion and had adequate data for evaluation. Twenty women (0.7%) had an ongoing pregnancy; 26 (0.9%) received curettage for retained tissue, empiric treatment for possible infection, or both; and 55 (1.8%) received additional uterotonics or other medical abortion-related care. Screening algorithms including patient-observed outcomes, a low-sensitivity pregnancy test, and nonsonographic clinical evaluation were as effective as sonography in identifying women who received interventions at or after the follow-up visit.Relying on women's observations, a low-sensitivity pregnancy test, and clinical examination, women and their providers can accurately assess whether follow-up care is required after medical abortion without routine ultrasonography.ClinicalTrials.gov, www.clinicaltrials.gov, NCT00120224.II.Keywords
This publication has 11 references indexed in Scilit:
- Accuracy of a semi-quantitative urine pregnancy test compared to serum beta-hCG measurement: a possible screening tool for ongoing pregnancy after medication abortionContraception, 2007
- Clinical utility of urine pregnancy assays to determine medical abortion outcome is limitedContraception, 2007
- Ability of the clinician and patient to predict the outcome of mifepristone and misoprostol medical abortionContraception, 2004
- Verifying the effectiveness of medical abortion; ultrasound versus hCG testingEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, 2003
- Mifepristone for early medical abortion: experiences in France, Great Britain and Sweden.Perspectives on Sexual and Reproductive Health, 2002
- Mifepristone followed on the same day by vaginal misoprostol for early abortionContraception, 2001
- Abortion with mifepristone and misoprostol: Regimens, efficacy, acceptability and future directionsAmerican Journal of Obstetrics and Gynecology, 2000
- Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt TraumaThe New England Journal of Medicine, 2000
- Selective Cervical Spine Radiography in Blunt Trauma: Methodology of the National Emergency X-Radiography Utilization Study (NEXUS)Annals of Emergency Medicine, 1998