Self-administered Follow-up Using a Low-sensitivity Pregnancy Test after Medical Abortion: Results of a Partially Randomized Patient Preference Trial.

INTRODUCTION

In Germany, follow-up after medical abortion is typically conducted via ultrasound examination. International evidence suggests that self-administered follow-up using low-sensitivity pregnancy tests may be a safe and acceptable alternative. This study assessed the effectiveness and acceptability of this approach within the German healthcare system.

METHODS

In this prospective, multicenter, partially randomized, patient preference study conducted in 11 German centers (March-September 2024) involving 312 women, participants with strong preferences could choose their preferred follow-up method, while all others were randomized to either self-testing or ultrasound follow-up. Follow-up was performed using a low-sensitivity pregnancy test (1000 mIU/ml) at home or by ultrasound examination in the clinic. The primary outcome was the detection of ongoing pregnancies; patient satisfaction was assessed as a secondary outcome.

RESULTS

The detection rate of ongoing pregnancies was 100% in both groups. Specificity was 92.7% in the self-testing group and 100% in the ultrasound group. Complications were rare and occurred at similar rates in both groups. Discordant cases were rare and mainly represented false-positive results with faint test lines near the cut-off; severe complications did not occur more frequently. Satisfaction with the follow-up method was slightly lower in the self-testing group (85.9%) compared to the ultrasound group (98.3%) but remained within an acceptable range. Subjective feelings of safety were high in both groups.

CONCLUSION

Self-administered follow-up using a low-sensitivity pregnancy test is a safe and well-accepted alternative to ultrasound examination after medical abortion. It may improve access to follow-up care, particularly for women living in underserved or remote areas.