Self-assessment is safe as follow-up of medical abortion

  • Baiju N & al.
  • BJOG
  • 31 ago. 2019

  • de Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Self-assessment at home for completed medical abortion is safe and effective and has many benefits.

Why this matters

  • Medical abortion is often elected for its privacy and accessibility, but follow-up visits can be burdensome, especially for women with limited financial resources.
  • Home self-assessment may shorten waiting and travel times, prevent missed school or work, improve confidentiality, and save medical resources.

Key results

  • No difference in effectiveness was seen between self-assessment and clinic follow-up (risk ratio [RR], 1.00; 95% CI, 0.99-1.01).
  • No differences seen between groups for need of follow-up surgery, hemorrhage, fever, infections, or ongoing pregnancy.
  • Acceptability was greater for self-assessment compared with in-clinic follow-up (81.91% vs 48.35%).

Study design

  • Systematic review and meta-analysis.
  • 4 randomized controlled clinical trials (n=5493 participants) included in final analysis.
  • Participants undergoing medical abortion at home were identified.
  • The intervention was a self-assessment of abortion outcome done by home urine pregnancy test combined with a follow-up home visit or telephone call to confirm termination of pregnancy.
  • Self-assessment at home was compared with traditional in-person clinic follow-up visit.
  • The primary outcome was successful complete abortion.
  • Funding: None.

Limitations

  • Small number of studies met inclusion criteria.