OBJECTIVE: To investigate phone follow-up with a semiquantitative urine pregnancy test and symptom checklist as a replacement for universal clinic follow-up after medical abortion.
METHODS: One thousand four hundred thirty-three women seeking early medical abortion at four hospitals in Vietnam were randomized to clinic or phone follow-up. Women allocated to clinic follow-up returned to the hospital for confirmation of abortion outcome 2 weeks after mifepristone administration. Women assigned to phone follow-up completed a semiquantitative pregnancy test at initial visit to determine baseline human chorionic gonadotropin range and again at home 2 weeks later. Clinic staff called women to review the pregnancy test results and symptom checklist. Women who screened positive were referred to the clinic. Effectiveness, feasibility, and acceptability of the follow-up methods were assessed.
RESULTS: The rate of ongoing pregnancy was not significantly different between the two groups (clinic: 2.7% phone, 2.5%, relative risk 0.9, 95% confidence interval 0.99–1.02). Eighty-five percent of women in the phone group did not need an additional clinic visit. Phone follow-up was highly effective in screening for ongoing pregnancy with a sensitivity and specificity of 92.8% and 90.6%, respectively. Specificity of the pregnancy test alone (eg, without the symptom checklist) was higher (95.7%).
CONCLUSION: Phone follow-up offers a feasible and effective approach to identify women with ongoing pregnancy after early medical abortion. When used with the semiquantitative pregnancy test, the symptom checklist offered no additional benefit and decreased the specificity of the screening. Given its effectiveness and ease of use, the semiquantitative pregnancy test alone could replace routine clinic follow-up after early medical abortion.
CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01150422.
LEVEL OF EVIDENCE: I
Phone follow-up with a semiquantitative urine pregnancy test is an effective method of identifying ongoing pregnancy after early medical abortion.
Center for Research and Consultancy in Reproductive Health, the HungVuong Hospital, and the HocMon General District Hospital, Ho Chi Minh City, and the National OBGYN Hospital, Hanoi, Vietnam; Gynuity Health Projects, New York, New York; and Stanford University, Palo Alto, California.
Corresponding author: Hillary Bracken, PhD, MHS, Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY 10010; e-mail: firstname.lastname@example.org.
Financial support for this study was provided by an anonymous donor.
The authors thank Nguyen Van Truong, Nguyen Dang Quang, Le Van Thanh, Le Thi Ngoc Hien, Duong Lan Dung, and Tran Hai Dung for their administrative support during the study.
Presented at the International Federation of Obstetrician and Gynecologists meeting, October 7–12, 2012, Rome, Italy.
Financial Disclosure The authors did not report any potential conflicts of interest.