Verifying the effectiveness of medical abortion; ultrasound versus hCG testing

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

“…Information on LTFU rates in medical abortion literature are derived from clinical trials and are highly variable due to differences in medication administration protocol, follow-up methods and timing, patient population and laws, as well as whether the data were collected prospectively or retrospectively. Most clinical trials report LTFU rates below 5% [6,[11][12][13][14][15][16][17][18][19].…”

“…Investigators have attempted to find more convenient and less expensive means of follow-up than an in-office visit, including urine pregnancy testing [4] and telephone follow-up [5]. A single study found that a decline in serum beta human chorionic gonadotropin (β-hCG) concentrations of at least 80% over 6 to 7 days after initiating treatment with mifepristone and misoprostol was indicative of a successful abortion [6]. Based on this data, Planned Parenthood Federation of America (PPFA), the largest provider of sexual and reproductive health services in the United States, instituted a protocol change for its clinics in 2008 [7].…”

Correlation between ultrasound and histopathological findings of products of uterine evacuation in cases admitted after medical abortion

“…In the latter case, antibiotic treatment should be initiated. [4][5][6] Ultrasound is typically the first-line investigation in suspected cases of retained products of conception (RPOC). Variable amount of echogenic or heterogeneous material within the endometrial cavity, presence of vascularity within the echogenic material supports the diagnosis, and helps to differentiate it from intrauterine blood clot.…”

“…[8][9][10] Many studies have concluded that most of the women regained normal menses without further surgical intervention following diagnosis of failed medical abortion, suggesting that remnants of trophoblastic tissue get spontaneously evacuated from the uterine cavity. 4,10 There is no agreement about the value of submitting tissue for histological examination obtained at uterine curettage in suspected cases of RPOC. One philosophy is to investigate only those women in whom there is some uncertainty over the diagnosis pre-operatively, or when there is doubt about the diagnosis at the time of the operation.…”

“…Cowett et al 6 found that the range of endometrial thickness after medical TOP was wide, with a significant overlap between the groups and they recommended that clinicians intervene not only when a persistent gestational sac is seen on TVS, but also on the basis of compelling clinical indications. Fiala et al 4 suggested that the sonographic findings on follow-up were sometimes difficult to interpret and may lead to unnecessary surgical intervention, and found that serum βHCG was more effective in the follow-up after medical abortion.…”