Wendy R. Sheldon
Home use of urine pregnancy tests for medical abortion follow-up
Gynuity Health Projects
lancet global health kirti iyengar colleagues1iyengar k paul iyengar sd et alselfassessment outcome early medical abortion versus clinic followup india randomised controlled noninferiority triallancet glob health 2015 3 e537e545summary full text full text pdf scopus 33 google scholar report findings randomised controlled noninferiority trial 731 women compared effectiveness standard clinic followup medical abortion versus selfassessment use lowsensitivity urine pregnancy test home primary outcome efficacy abortion procedure defined complete abortion without need additional clinical intervention within 30 days study enrolment findings showed significant differences two study groups 95 women homeassessment group reported complete abortion compared 93 women clinic followup group study addresses important question whether routine clinic followup medical abortion responsively eliminated service delivery protocols thus reducing key barrier accessing medical abortion service change could especially beneficial women rural lowresource settings rajasthan india study done findings also underscore high efficacy safety early medical abortion regimen 200 mg mifepristone followed misoprostol2raymond eg shannon c weaver et alfirst trimester medical abortion mifepristone 200 mg misoprostol systematic reviewcontraception 2013 87 2637summary full text full text pdf pubmed scopus 139 google scholar thus confirming women need clinic followup yet investigators main conclusionthat selfassessment medical abortion home use lowsensitivity pregnancy test effective clinicbased followupseems premature especially given primary outcome used study efficacy abortion procedure clinical perspective important reason using urine pregnancy tests medical abortion identify possible cases ongoing pregnancy might otherwise go undetected shortterm absence routine clinic followup recognition several studies topic detection continuing pregnancy primary outcome3blum j shochet lynd k et alcan athome semiquantitative pregnancy tests server replacement clinical followup medical abortion us studycontraception 2012 86 757762summary full text full text pdf pubmed scopus 51 google scholar 4lynd k blum j ngoc nt et alsimplified medical abortion using semiquantitative pregnancy test homebased followupint j gynaecol obstet 2013 121 144148summary full text full text pdf pubmed scopus 27 google scholar 5ngoc nt bracken h blum j et alacceptability feasibility phone followup early medical abortion vietnam randomized controlled trialobstet gynecol 2014 123 8895crossref pubmed scopus 41 google scholar 6michie l cameron st simplified followup early medical abortion 12month experience telephone call selfperformed lowsensitivity urine pregnancy testcontraception 2014 89 440445summary full text full text pdf pubmed scopus 38 google scholar 7platais tsereteli comendant r et alacceptability feasibility phone followup semiquantitative urine pregnancy test medical abortion moldova uzbekistancontraception 2015 91 178183summary full text full text pdf pubmed scopus 20 google scholar 8cameron st glasier dewart h et altelephone followup selfperformed urine pregnancy testing medical abortion service evaluationcontraception 2012 86 6773summary full text full text pdf pubmed scopus 57 google scholar arguably outcome greatest importance medical abortion followup given need rapid accurate recognition study iyengar colleagues five continuing pregnancies identified clinic followup group compared two homeassessment group although differences statistically significant cannot know certain continuing pregnancies homeassessment group went undetected either human test error since outcomes group determined womans selfreport test results furthermore since study primarily concerned overall effectiveness abortion procedure powered detect differences incidence ongoing pregnancy iyengar colleagues researchers stymied practical methodological complexities assessing home followup medical abortion study oppegaard colleagues9oppegaard ks qvigstad e fiala c et alclinical followup compared selfassessment outcome medical abortion multicentre noninferiority randomised controlled triallancet 2015 385 698704summary full text full text pdf pubmed scopus 57 google scholar compared standard clinic followup versus home assessment semiquantitative pregnancy test also selected effectiveness abortion procedure primary outcome study 924 women four european countries complete abortion reported 94 women selfassessment group compared 95 clinic followup group results led finding noninferiority despite fact none three continuing pregnancies selfassessment group detected test study iyengar colleagues additional continuing pregnancies subsequently identified women exited study however outcome could result challenges maintaining contact study participants rural lowliteracy setting study done yet studies affirm safety home assessment medical abortion cases incidence adverse events haemorrhage infection hospital admission higher women home followup routine clinic followup discrepancy primary outcomes used investigate home assessment urine pregnancy tests medical abortion ultimately raises question information essentialboth research clinical purposes although detection continuing pregnancy crucial outcome requires additional clinical intervention could otherwise go undetected short term perhaps assurance continuing pregnancies always detected home use urine pregnancy tests essential prerequisite elimination routine followup visit provision highquality medical abortion care indeed continuing pregnancies eventually detected pose health risks women meantime already come conclusion recent abortion guidelines10whosafe abortion technical policy guidance health systems world health organization geneva2012httpappswhointirisbitstream106657091419789241548434engpdfgoogle scholar stipulate routine clinical followup needed medical abortion repeat hcg testing used confirm complete outcome maybe time go one step removing routine followup requirements sort medical abortion service delivery protocols bolstered part knowledge studies iyengar colleagues confirm effectiveness medical abortion procedure ability women safely determine clinic followup needed declare competing interests selfassessment outcome early medical abortion versus clinic followup india randomised controlled noninferiority trialhome assessment medical abortion outcome lowsensitivity urine pregnancy test noninferior clinic followup could introduced instead clinic followup visit lowresource setting fulltext pdf open access