Abstract
Introduction
In Germany, follow-up after medical abortion is typically conducted via ultrasound
examination. International evidence suggests that self-administered follow-up using
low-sensitivity pregnancy tests may be a safe and acceptable alternative. This study
assessed the effectiveness and acceptability of this approach within the German healthcare
system.
Methods
In this prospective, multicenter, partially randomized, patient preference study conducted
in 11 German centers (March–September 2024) involving 312 women, participants with
strong preferences could choose their preferred follow-up method, while all others
were randomized to either self-testing or ultrasound follow-up. Follow-up was performed
using a low-sensitivity pregnancy test (1000 mIU/ml) at home or by ultrasound examination
in the clinic. The primary outcome was the detection of ongoing pregnancies; patient
satisfaction was assessed as a secondary outcome.
Results
The detection rate of ongoing pregnancies was 100% in both groups. Specificity was
92.7% in the self-testing group and 100% in the ultrasound group. Complications were
rare and occurred at similar rates in both groups. Discordant cases were rare and
mainly represented false-positive results with faint test lines near the cut-off;
severe complications did not occur more frequently. Satisfaction with the follow-up
method was slightly lower in the self-testing group (85.9%) compared to the ultrasound
group (98.3%) but remained within an acceptable range. Subjective feelings of safety
were high in both groups.
Conclusion
Self-administered follow-up using a low-sensitivity pregnancy test is a safe and well-accepted
alternative to ultrasound examination after medical abortion. It may improve access
to follow-up care, particularly for women living in underserved or remote areas.
Keywords
outpatient care - medical abortion - follow-up care - low-sensitivity pregnancy test
- patient satisfaction
