Update on medication abortion follow-up options: many sizes to fit all

Purpose of review To assess the efficacy, benefits, and limitations of available and emerging follow-up options for medication abortion. Recent findings Medication abortion follow-up does not have to be a 'one size fits all' protocol. From most to least invasive, follow-up options include facility-based ultrasound, laboratory-based repeat serum beta-human chorionic gonadotropin (hCG) testing, urine hCG testing (high sensitivity, low sensitivity, and multilevel pregnancy tests), self-assessment with symptom evaluation, and no intervention. Provider or facility-dependent follow-up, including ultrasound and serum testing are effective, but have several limitations, including needing to return to a facility and cost. Remote, client-led follow-up options, such as urine pregnancy testing and symptoms evaluation, are well tolerated and effective for ruling out the rare outcome of ongoing pregnancy after medication abortion and have several advantages. Advantages include being inexpensive and flexible. However, it is important to note that low-sensitivity and multilevel pregnancy tests are not available in all settings. In studies evaluating client-led follow-up with urine pregnancy tests, ongoing pregnancies were identified over half the time with symptoms alone. Guidelines from several professional organizations have aligned with the evidence and no longer recommend routine office-based follow-up. To ensure care is person-centered, providers should offer follow-up options that align with the comfort, logistical ability, and values of the client.

Automated summary

The purpose of this review is to assess the effectiveness, benefits, and limitations of different follow-up options for medication abortion. The findings suggest that follow-up does not have to be a standardized protocol, and various options are available depending on the preferences and circumstances of the patient. From most invasive to least invasive, follow-up options include facility-based ultrasound, laboratory-based serum testing, urine pregnancy testing, self-assessment with symptoms evaluation, and no intervention. Client-led follow-up options such as urine pregnancy testing and symptoms evaluation are well tolerated, cost-effective, and flexible for ruling out ongoing pregnancy after medication abortion.