Self-administered multi-level pregnancy tests in simplified follow-up of medical abortion in Tunisia

This study was conducted to assess the efficacy and acceptability of using a multi-level pregnancy test (MLPT) combined with telephone follow-up for medical abortion in Tunisia, where the majority of providers are midwives. Four hundred and four women with gestational age ≤ 70 days' LMP seeking...

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Bibliographic Details
Published in:	BMC women's health Vol. 16; no. 1; p. 49
Main Authors:	Dabash, Rasha, Shochet, Tara, Hajri, Selma, Chelli, Héla, Hassairi, Anne-Emmanuele, Haleb, Douha, Labassi, Hayet, Sfar, Ezzedine, Temimi, Fatma, Koenig, Leah, Winikoff, Beverly
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 30-07-2016 BioMed Central
Subjects:	Abortion Abortion, Induced Adolescent Adult Aftercare - methods Counseling Diagnosis Family planning Female Gestational Age Health aspects Health Education - methods Health Education - standards Health facilities Hospitals Humans Middle Aged Midwifery Mifepristone - pharmacology Mifepristone - therapeutic use Misoprostol - pharmacology Misoprostol - therapeutic use Pregnancy Pregnancy Tests - methods Pregnancy Tests - standards Pregnant women Prospective Studies Self Administration - methods Self Administration - standards Tunisia Ultrasonic imaging Womens health Tunisia United States > US Multi-level pregnancy test Semi-quantitative pregnancy test Tunisia Medical abortion
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Summary:	This study was conducted to assess the efficacy and acceptability of using a multi-level pregnancy test (MLPT) combined with telephone follow-up for medical abortion in Tunisia, where the majority of providers are midwives. Four hundred and four women with gestational age ≤ 70 days' LMP seeking medical abortion at six study sites were enrolled in this open-label trial. Participants administered a baseline MLPT at the clinic prior to mifepristone administration and were asked to take a second MLPT at home and to call in its results before returning the day of their scheduled follow-up visit 10-14 days later. Almost all women with follow-up (97.1 %, n = 332/342) had successful abortions without the need for surgical intervention. The MLPT worked extremely well among women ≤63 days' LMP in ruling out ongoing pregnancy (negative predictive value (NPV) =100 % (n = 298/298)) and also detecting women with ongoing pregnancies (sensitivity = 100 %; 2/2) as needing follow-up due to non-declining hCG. Among women 64-70 days' LMP, the test also worked well in ruling out ongoing pregnancy (NPV = 96.9 % (n = 31/32) but not as well in terms of sensitivity (50 %), with only one of two ongoing pregnancies detected by MLPT as needing follow-up. Most women (95.1 %) found the MLPT to be very easy or easy to use and would consider using the MLPT again (97.4 %) if needed. Self-administered pre and post MLPT are very easy for women to use and accurate in assessing medical abortion success up to 63 days' LMP. MLPT use for medical abortion follow-up has the potential to facilitate task sharing services and eliminate the burden of routine in-person follow-up visits for the large majority of women. Additional research is warranted to explore the accuracy of the MLPT in identifying ongoing pregnancy among women with gestational ages > 63 days. This study was registered on May 13, 2010, on clinicaltrials.gov as NCT01150279 .
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	1472-6874 1472-6874
DOI:	10.1186/s12905-016-0327-1