Home abortion follow-up test safe: Study

An at-home test to verify whether a medical abortion has worked is safe and less burdensome for patients, according to an Australian-led study.
 
Currently, patients who undergo an early medical abortion (EMA) typically follow up with their doctor face-to-face 14 days after taking medication to exclude complications.
 
But a new MSI Australia study, published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, has found a low sensitivity urine pregnancy test (LSUPT) and a telehealth evaluation with a questionnaire is equally as effective and safe.
 
‘It minimises not only travel itself, but the additional financial burdens associated with in-clinic appointments, such as time off work and arranging childcare,’ researchers found.
 
From 26 March to 31 July 2020, the study followed 3503 patients who underwent an EMA.
 
Of those patients, 63.5% (2223) completed the new protocol, undertaking a LSUPT at home.
 
The study found 8.9% of those patients had a positive LSUPT and required an in-clinic appointment, while the vast majority (91.1%) did not require a further appointment.
 
The at-home test also led to a reduction in surgical intervention for incomplete abortion.
 
The report’s authors, including MSI Australia deputy medical director Catriona Melville, say the research represents progress for women accessing timely and quality healthcare.
 
‘Simplifying follow up after EMA is another step toward self-managed abortion care and is an opportunity to reduce inequities and improve access to this essential component of reproductive healthcare,’ the study concluded.
 
Monash University General Practice Chair, Professor Danielle Mazza told newsGP currently, accessing medical abortions can be an onerous task for women, often requiring several visits to healthcare professionals.
 
‘There’s a lot of pressure on women to get organised and they’ve all got busy lives and often have other children and work and lots of other responsibilities,’ Professor Mazza said.
 
‘Women struggle to navigate the services and they also have the gestational time limit of medical abortion – in Australia it has to be conducted by nine weeks.
 
‘This protocol allows for the ability for [women] to do that test and not have to go and do a blood test and wait for a result.’
 
But she said the tests are currently not readily available in Australia.
 
LSUPT has been accessible in other countries for more than a decade but was only approved by the Australian Therapeutic Goods Administration (TGA) in November 2019.
 
A 2020 study from women’s healthcare company, Organon, found 40% of all pregnancies in Australia are unintended, and around one third are terminated.
 
Those living in rural areas are 1.4 times more likely to experience an unintended pregnancy than women living in a metro setting.
 
Last month, the TGA announced the lifting of several restrictions around prescribing mifepristone and misoprostol (MS-2 Step) for medical terminations.
 
Since 1 August, GPs are no longer required to undertake mandatory training and registration to prescribe the medication, and any healthcare professional with appropriate qualifications can prescribe MS-2 Step.
 
Professor Mazza said those changes, alongside the new research, would go a long way in creating a more accessible healthcare system for women, especially those living regionally.  
 
‘That’s been the whole aim, to destigmatise it as, it’s an essential form of women’s healthcare,’ she said.
 
‘I think that with the advent of medical abortion and these LSUPT, it makes it all more feasible and more acceptable and easier to deliver.
 
‘It’s just taking away barriers, and stigma is one of those barriers.’
 
In March 2022, MSI Australia rolled out a patient-led follow-up program using the LSUPT and a self-administered questionnaire, a model which is still being closely monitored and evaluated.
 
More information on increasing women’s access to medical abortions can be found on the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) website.
 
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