Home follow-up saves most women a return visit to the clinic
Wednesday, August 04, 2010
A recent study, “Feasibility of telephone follow-up after medical abortion,” published in Contraception, demonstrated that at least 64 percent of women who have medical abortion don’t need to return to the clinic for follow-up. In this study, 139 women who had medical abortion up to 63 days of gestation received mifepristone in the clinic, used misoprostol at home and had a phone follow-up one week later, and 30 days after taking mifepristone, the women performed an ordinary (highly sensitive urine pregnancy test) at home.
Six women returned prior to the one-week telephone call: One had a continuing pregnancy, two had a uterine aspiration for bleeding, and three didn’t need treatment.
Standard questions asked during the telephone conversation one week after mifepristone was taken were:
1. Did you have cramping and bleeding heavier than a period?
2. Did you pass clots or tissue?
3. What was the highest number of pads you soaked per hour?
4. Do you still feel pregnant now?
5. Do you think you passed the pregnancy?
All women were contacted, and 94 percent indicated that they had probably passed the pregnancy and no longer felt pregnant. On the basis of their answers, eight women were asked to come to the clinic for assessment. Two had a uterine evacuation for ongoing pregnancy, one was given additional misoprostol, and the remaining women didn’t need any treatment.
One month after taking mifepristone, 117 women remained in the study who had not been physically examined either prior to the phone consultation due to self-referral or because of concerns based on the phone consultation. Approximately 75 percent had a negative pregnancy test and didn’t need further follow-up. Almost 24 percent of the women had either a positive or inconclusive urine pregnancy test. All of these women were asked to return to the clinic, but in the end, none had an ongoing pregnancy. So many pregnancy tests were still positive or inconclusive (unclear) because hCG levels are at their highest right around the time a woman receives medical abortion at 8-9 weeks; hCG levels can be as high as 100,000 mIU/ml or even higher. Even if a medical abortion is successful and the hCG level has dropped by 99 percent in 30 days, the level will be 1000 mIU/ml, which is higher than the sensitivity of the ordinary pregnancy test (25 mIU/ml). Research is underway to examine the use of a less sensitive urine pregnancy test for home follow-up.
In the study, women choosing oral contraception, transdermal patches or hormonal vaginal rings were given a prescription and arrangements were made for those choosing injectable, implantable or intrauterine contraception. “If follow-up is simplified so women don’t return to the clinic, it’s imperative to discuss contraception at the time the woman receives mifepristone. Many hormonal methods can be started on the same day the woman takes misoprostol. If the woman desires a method that requires provider administration (such as DMPA, implants, intrauterine contraception or sterilization), she should be scheduled for a clinic visit to receive those methods,” Dr. Perriera told Medical Abortion Matters.
Dr. Perriera added, “Simplified telephone follow-up provides women with another choice for follow-up, and may provide them with more control over the abortion process. For women who feel comfortable with this method of follow-up, I hope that it will be offered as an option in the future.”