Detection of ectopic pregnancy and serum beta hCG levels in women undergoing very early medical abortion: a retrospective cohort study

Very early medical abortion: treatment with mifepristone and misoprostol before ultrasonographic visualisation of an intrauterine pregnancy

“…The rate of ectopic pregnancy was 5.3% in those with an empty uterus at baseline, 2% in those with a sac-like structure, and 4.4% overall. This was similar to that previously reported by a different service (4.7%) that investigated ectopic prevalence among patients seeking abortion without ultrasound evidence of IUP,9 but lower than the 7.9% reported in another recent study 10. The ectopic prevalence among the general population attending early pregnancy units in the UK is 2–3% 21.…”

“…Although overall numbers in our study are small, this nonetheless provides some reassurance that VEMA patients were not disadvantaged in time to ectopic pregnancy diagnosis. This is also in keeping with findings from existing studies that VEMA may even assist early diagnosis of ectopic pregnancy in asymptomatic patients without ultrasound evidence of IUP,9 10 since patients with suboptimal decreases in serum-hCG automatically constitute those at higher risk of ectopic pregnancy. It is noteworthy that the delayed group patients with ruptured ectopic pregnancy requiring emergency intervention had not adhered to follow-ups.…”

“…They returned on day 8 for follow-up serum-hCG measurement. Based on existing literature on serum-hCG kinetics during medical abortion,9 15 16 and following multidisciplinary discussions with the regional early pregnancy unit, complete abortion was defined as ≥80% decrease in serum-hCG at day 8, compared with day 1.…”

“…There is also evidence that commencing medical abortion in very early pregnancy (ie, before ultrasound visualisation of probable IUP) is safe and effective when undertaken alongside a robust protocol with close monitoring of serum-hCG levels for a satisfactory percentage decline at day 8 of abortion compared with baseline (day 1) 8–10. A systematic review conducted as part of the 2019 National Institute of Health and Care Excellence (NICE) guidelines on abortion care concluded that commencing abortion before ultrasound evidence of IUP was not associated with a significantly higher rate of missed ectopic pregnancy diagnoses 11…”

Medical Abortion before Confirmed Intrauterine Pregnancy: A Systematic Review

“…Diagnosis may also take place after treatment has been completed and hCG levels have not fallen as predicted. One study found that the mean decrease in s-hCG between days 5 and 10 post-mifepristone was 93% 8 ; however, most study protocols allowed a smaller reduction in s-hCG. For those with a smaller reduction in hCG, likelihood of ectopic needs to be correlated with scan findings, symptoms, and indeed timing of s-hCG levels.…”