Comparison of medical abortion follow-up with serum human chorionic gonadotropin testing and in-office assessment

Background: The study was conducted to compare lost to follow-up (LTFU) rates in women having a medical abortion who chose follow-up by in-office ultrasound assessment or serum beta human chorionic gonadotropin (β-hCG) testing. Methods: This retrospective chart review included 865 women who underwent medical abortion in a free-standing outpatient clinic from September 1, 2007, through September 30, 2010. Patients had a 1-week follow-up evaluation after receiving the medications consisting of in-office ultrasound assessment or serial serum β-hCG testing. Ultrasound assessment was offered throughout the study period, and serum β-hCG testing was offered as of September 1, 2008. Demographic and medical data were reviewed to evaluate LTFU rates based on patient's chosen method of follow-up. Multivariable logistic regression analysis was performed to evaluate factors that were independently associated with lack of follow-up. Results: LTFU rates increased from 18% to 27% in the first and third years of the study period, respectively (p=.009). LTFU rates with ultrasound and β-hCG testing were 22.9% and 33.7%, respectively (p=.024). In multivariable analysis, follow-up method was not associated with increased LTFU. Increased parity, any previous induced abortion, increased distance from home to clinic site and unemployment were independently associated with increased LTFU. Conclusions: Although LTFU rates are higher with serum β-hCG testing than in-office ultrasound follow-up in our patient population, the women who choose this method are inherently more likely not to follow-up because of other characteristics that predict a high likelihood of being LTFU. Offering serum β-hCG testing does not decrease the LTFU rate in women having a medical abortion.