Medication Abortion Self-Confirmation (MASC): Comparison of Two Home Pregnancy Tests as an Alternative to Office Follow Up

OBJECTIVES: Medication abortions are highly effective and associated with low complication rates. To ensure the absence of an ongoing pregnancy, follow-up clinic visits are routine and commonly involve ultrasound, serum hCG testing, or both. However, studies also support the use of self-performed urine pregnancy tests at home to confirm decreased -hCG levels and successful pregnancy termination without a clinic visit. Two urine pregnancy tests (UPTs), a 5-bracket multilevel pregnancy test (MLPT) and a 1000 mIU/mL low-sensitivity pregnancy test (LSPT), have been evaluated for this purpose. To date, the ability of women to independently use each test and accurately interpret the results has not been rigorously or comparatively studied. The primary objective was to evaluate women’s ability to comprehend abortion status using two different UPTs (MLPT and LSPT). Our secondary objectives were to evaluate 1) ease of use of both tests, and 2) patient satisfaction.

METHODS: This was an exploratory randomized investigation. All women from an outpatient clinic with intrauterine pregnancies through 63-days gestation seeking medication abortion were approached for enrollment. We planned to enroll a convenience sample of up to 100 women. Participants were randomized to use either the MLPT or LSPT at home and provided instructions to determine abortion completion status. On days 7 and possibly day 14, participants performed their assigned UPT at home and completed an electronic questionnaire to document pregnancy test result and evaluate symptoms. Lastly, satisfaction and acceptability of this follow-up process were ascertained via electronic questionnaire on day 14. Questionnaires utilized multiple choice, 5-point Likert and visual analogue scales (0-100), and free response style questions.

RESULTS: Eighty-eight women were enrolled. Forty-three women were randomized to LSPT group and 45 were randomized to MLPT group. In the LSPT group, 97.4% (n=38) correctly interpreted their final test result compared to 91.1% in the MLPT group (n=41), (p=0.37). When the test demonstrated an ongoing pregnancy, all 3 women in the LSPT group correctly interpreted the result, compared to 2 of 3 in the MLPT group. Both the LSPT and MLPT results were reported as “very easy” to comprehend (i.e., a mean rating of 9 and 13, respectively, on a 100-point scale with 0 being very easy and 100 being very difficult). Eighty-nine percent and 95% of women in the LSPT and MLPT groups, respectively, were “likely” or “very likely” to recommend use of their assigned tests for medication abortion follow-up.

CONCLUSION: There were no clinically or statistically significant differences between the LSPT and MLPT in comprehension of results, subject-reported ease of use and interpretation, or likelihood to recommend the test to others. Given high comprehension rates and acceptability, both urine pregnancy tests may be used with medication abortions as alternatives to in-person clinic follow up. Future cost-effectiveness studies to compare LSPT and MLPT for remote follow up may inform and guide practice.