title: Serial multilevel urine pregnancy testing to assess medical abortion outcome: a meta-analysis.
abstract: OBJECTIVE
  To summarize data on the accuracy of a strategy designed to exclude ongoing pregnancy after medical abortion treatment by observing a decline in urine human chorionic gonadotropin (hCG) concentration as estimated by multilevel urine pregnancy tests (MLPTs) performed before and after treatment.
  
  
  METHODS
  We collated original data from seven studies performed by our organization that evaluated the accuracy of the MLPT strategy for assessment of outcome of medical abortion. Our first analysis included data from the five studies in which each participant was evaluated both with the MLPT strategy and with ultrasound or other clinical assessment. Our second analysis combined data from two randomized trials that compared the MLPT strategy to assessment by ultrasound. Both analyses included only participants treated at ≤63 days of gestation.
  
  
  RESULTS
  In the first analysis, 1482 (93%) of 1599 participants had a decline in hCG concentration after treatment. Twenty-one (1.3%) had an ongoing pregnancy, none of whom had a decline (predictive value 100%, 95% CI 93.3%, 100%). The remaining 96 women (6.0%) had no decline without an ongoing pregnancy. The second analysis, which included 3762 participants with follow-up, found no significant difference in the rates of ongoing pregnancy ascertained in the randomized groups (RR 0.88; 95% CI 0.50, 1.54). Nearly all of the post-treatment MLPTs in the seven studies (3484/3535; 99%) were performed by the participants themselves.
  
  
  CONCLUSIONS
  Serial multilevel urine pregnancy testing is a highly reliable and efficient strategy for excluding ongoing pregnancy after medical abortion at≤63 days of gestation.
  
  
  CONCLUSIONS
  Serial urine testing using MLPTs can obviate the need for routine ultrasound or examination after medical abortion treatment and can allow most women to avoid an in-person follow-up visit to the abortion facility.
authors.affiliation: Gynuity Health Projects, 15 E 26th Street, Suite 801, New York, NY, 10010, USA. Electronic address: eraymond@gynuity.org.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Raymond
authors.affiliation: Gynuity Health Projects, 15 E 26th Street, Suite 801, New York, NY, 10010, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Shochet
authors.affiliation: Gynuity Health Projects, 15 E 26th Street, Suite 801, New York, NY, 10010, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blum
authors.affiliation: Gynuity Health Projects, 15 E 26th Street, Suite 801, New York, NY, 10010, USA.
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Sheldon
authors.affiliation: Gynuity Health Projects, 15 E 26th Street, Suite 801, New York, NY, 10010, USA.
authors.forename: Ingrida
authors.initials: I
authors.lastname: Platais
authors.affiliation: Gynuity Health Projects, 15 E 26th Street, Suite 801, New York, NY, 10010, USA.
authors.forename: Hillary
authors.initials: H
authors.lastname: Bracken
authors.affiliation: Gynuity Health Projects, 15 E 26th Street, Suite 801, New York, NY, 10010, USA.
authors.forename: Rasha
authors.initials: R
authors.lastname: Dabash
authors.affiliation: University of North Carolina at Chapel Hill, Departments of Medicine and Biostatistics, Chapel Hill, NC, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
authors.affiliation: Center for Research and Consultancy in Reproductive Health, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen Thi Nhu
authors.initials: NTN
authors.lastname: Ngoc
authors.affiliation: Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Blumenthal
authors.affiliation: Gynuity Health Projects, 15 E 26th Street, Suite 801, New York, NY, 10010, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Winikoff
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D000028:Abortion, Induced / Q000379:methods*; D006063:Chorionic Gonadotropin / Q000652:urine*; D005260:Female; D006801:Humans; D015735:Mifepristone / Q000008:administration & dosage; D016595:Misoprostol / Q000008:administration & dosage; D011247:Pregnancy; D011258:Pregnancy Tests / Q000379:methods*; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D006063:Chorionic Gonadotropin; D016595:Misoprostol; D015735:Mifepristone
keywords: Diagnostic accuracy; Follow-up; Human chorionic gonadotropin; Medical abortion; Multilevel pregnancy test; Semiquantitative pregnancy test