title: Feasibility of self-performed urine pregnancy testing for follow-up after medical abortion.
abstract: OBJECTIVE
  Medical termination of pregnancy (MToP) follow-up can be simplified by combining a clinical assessment with blood and urine human chorionic gonadotropin (hCG) measurements, the later using a low sensitivity urinary pregnancy (LSUP) testing. This study aimed to describe follow-up modalities of MToP in real-life conditions, and assess the benefit of a self-performed urine semiquantitative test in the follow-up of MToP and its feasibility, acceptability and user-friendliness as well as the women capacity to interpret it correctly. Concordance between qualitative results from LSUP test and quantitative values from the blood hCG measurement was also assessed.
  
  
  METHODS
  From May to November 2013, we conducted a national, prospective, observational study with 17 centres offering MToP. Pregnant women with at least 63 days of amenorrhea (DA) requesting MToP were recruited during a consultation visit for medical abortion.
  
  
  RESULTS
  A total of 322 women were included (mean age: 28.1 ± 6.4 years). The mean term of pregnancy at the time of MToP was 44.1 ± 6.2 DA. Two regimens were mostly used: 200 and 600 mg mifepristone followed by 800 μg of misoprostol (51.5 and 33.3% of patients, respectively). 82.0% of women attended the follow-up visit (N=264), 5.0% were reached by phone and 13.0% were lost to follow-up. 86.2% of women performed blood and urine measurements, as requested, on the same day (± one day). The MToP success rate was 93.6% of women. There were two ongoing pregnancies (0.7%) and 16 retained products of conception (5.7%). The overall concordance between urine and blood hCG levels was estimated at 94.5% CI95% [90.2%; 97.4%]. According to the physician's opinion, a majority of women (89.6%) read the urine test correctly. Self-performing the LSUP test at home was found reassuring for 39.9% of women, and satisfactory for 25.8% of them, but 2.8% considered it to be alarming and 11.8% unsettling.
  
  
  CONCLUSIONS
  In our study, a self-performed LSUP test showed good concordance with blood test and appeared to be relevant, efficient and safe for women to monitor MToP success.
authors.affiliation: Private Practice Office, 5 place Léon Blum, Paris 75011, France. Electronic address: d.Hassoun@orange.fr.
authors.forename: Danielle
authors.initials: D
authors.lastname: Hassoun
authors.affiliation: Gynaecology Department, Delafontaine Hospital, Rue du Dr Delafontaine, 93260 Saint Denis, France.
authors.forename: Inès
authors.initials: I
authors.lastname: Périn
authors.affiliation: CMS Marc Chagall, 3 rue Simonneau, 92110 Clichy, France.
authors.forename: Helena
authors.initials: H
authors.lastname: Hiên
authors.affiliation: Medical Department, 75007 Paris, France.
authors.forename: Hélène Herman
authors.initials: HH
authors.lastname: Demars
mesh_terms: D000019:Abortifacient Agents / Q000627:therapeutic use; D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D000359:Aftercare / Q000379:methods; D006063:Chorionic Gonadotropin / Q000652:urine*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D059012:Lost to Follow-Up; D015735:Mifepristone / Q000627:therapeutic use; D016595:Misoprostol / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011258:Pregnancy Tests / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000019:Abortifacient Agents; D006063:Chorionic Gonadotropin; D016595:Misoprostol; D015735:Mifepristone
keywords: Acceptability; Human chorionic gonadotropin; Low-sensitivity pregnancy test; Medical abortion; Medical termination of pregnancy; Simplified follow-up