Can women determine the success of early medical termination of pregnancy themselves?

• Published in: Contraception (Stoneham) Vol. 91; no. 1; pp. 6 - 11
• Main Authors: Cameron, S.T, Glasier, A, Johnstone, A, Dewart, H, Campbell, A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2015
• Subjects: Abortion, Incomplete - diagnosis; Abortion, Incomplete - epidemiology; Abortion, Incomplete - therapy; Abortion, Incomplete - urine; Abortion, Induced - adverse effects; Adolescent; Adult; Chorionic Gonadotropin - urine; Cohort Studies; Community Health Centers; Diagnostic Self Evaluation; Female; Follow-Up Studies; Humans; Low sensitivity pregnancy test; Medical abortion; Middle Aged; Mifepristone; Misoprostol; Obstetrics and Gynecology; Outpatient Clinics, Hospital; Patient Compliance; Patient Education as Topic; Pregnancy; Pregnancy Tests; Pregnancy Trimester, First; Retrospective Studies; Risk; Scotland - epidemiology; Urban Health Services; Young Adult; Scotland; Mifepristone; Low sensitivity pregnancy test; Misoprostol; Medical abortion
• DOI: 10.1016/j.contraception.2014.09.009
• ISSN: 0010-7824

Abstract Objective To determine the outcome of early medical termination of pregnancy (TOP) among women who choose a “self assessment” follow up comprising a self-performed low sensitivity urine pregnancy test with instructions on signs/symptoms that mandate contacting the TOP service. Study design A retrospective review of computer databases of 1726 women choosing self-assessment after early medical TOP (< 9 weeks) in the UK. The main outcome measures were (a) number of women choosing self-assessment, (b) contact rates with TOP service and (c) time to presentation with an ongoing pregnancy (failed TOP). Results Ninety-six percent of women having an early medical TOP and going home to expel the pregnancy chose self-assessment. Two percent of women made unscheduled visits to the TOP service. One hundred and eighty-eight women (11%) telephoned the service about concerns related to complications or the success of treatment. There were eight ongoing pregnancies (0.5%; 95% confidence interval 0.2–0.9%). Four were detected within 4 weeks of treatment; the remainder were not detected until one or more missed menses after the procedure. Conclusions Most women having an early medical TOP, who go home to expel the pregnancy, choose self-assessment. Relatively few women make unscheduled visits or telephone the TOP service. Most ongoing pregnancies are recognized at an early stage, although late presentation (as with all methods of follow up) does still occur. Implications statement If women are given clear instructions on how and when to conduct a urine pregnancy test and on signs/symptoms that mandate contacting the TOP service, then they can confirm the success of early medical TOP themselves. Late presentation due to failure to recognize an ongoing pregnancy is rare.