title: Alternatives to ultrasound for follow-up after medication abortion: a systematic review.
abstract: BACKGROUND
  Requiring a follow-up visit with ultrasound evaluation to confirm completion after medication abortion can be a barrier to providing the service.
  
  
  METHODS
  The PubMed (including MEDLINE), Cochrane Central Register of Controlled Trials and POPLINE databases were systematically searched in October and November 2009 for studies related to alternative follow-up modalities after first-trimester medication abortion to diagnose ongoing pregnancy or retained gestational sac. We calculated the sensitivity, specificity, positive predictive value and negative predictive value compared with ultrasound or clinician's exam. We also calculated the proportion of cases in each study with a positive screening test.
  
  
  RESULTS
  Our search identified eight articles. The most promising modalities included serum human chorionic gonadotropin measurements, standardized assessment of women's symptoms combined with low-sensitivity urine pregnancy testing and telephone consultation. These follow-up modalities had sensitivities ≥90%, negative predictive values ≥99% and proportions of "screen-positives" ≤33%.
  
  
  CONCLUSIONS
  Alternatives to routine in-person follow-up visits after medication abortion are accurate at diagnosing ongoing pregnancy. Additional research is needed to demonstrate the accuracy, acceptability and feasibility of alternative follow-up modalities in practice, particularly of home-based urine testing combined with self-assessment and/or clinician-assisted assessment.
authors.affiliation: Ibis Reproductive Health, Oakland, CA 94612, USA. dgrossman@ibisreproductivehealth.org
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
authors.forename: Kate
authors.initials: K
authors.lastname: Grindlay
mesh_terms: D000028:Abortion, Induced; D006063:Chorionic Gonadotropin / Q000097:blood*; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D011247:Pregnancy / Q000097:blood / Q000652:urine; D011258:Pregnancy Tests; D017211:Treatment Failure; D014463:Ultrasonography
chemical_list: D006063:Chorionic Gonadotropin