In this Q&A, Contraceptive Technology Update asked Patricia A. Lohr, MD, MPH, medical director and director of the Centre for Reproductive Research & Communication at the British Pregnancy Advisory Service (BPAS) in the United Kingdom to explain how her new study’s findings suggest the usefulness of the low-sensitivity urine pregnancy test for use after a self-managed medication abortion.1 This transcript has been lightly edited for length and clarity.
CTU: Please describe the study’s purpose and findings. What type of low-sensitivity pregnancy test was used? For instance, is this referring to tests that any person can get over the counter at a pharmacy?
Lohr: We sought to understand whether the low-sensitivity urine pregnancy test and symptom checklist that we used at BPAS for self-assessment of medical abortion outcome, up to nine weeks of gestation, could be used up to 10 weeks of gestation. The [home] pregnancy test used in this study isn’t the same as an over-the-counter test that you can buy at a pharmacy. It is called the Check 4 and is made by a company called Quadratech.2 This test will read positive if the urine hCG level is 1,000 mIU/mL or greater as compared to high-sensitivity tests, which read positive at 15-25 mIU/mL.
To test the model, we compared pregnancy test positivity and triggers on the symptom checklist to an ultrasound, looking specifically for ongoing pregnancy.
CTU: Was the accuracy of the low-sensitivity pregnancy test as expected?
Lohr: The low-sensitivity pregnancy test performed very well and picked up all the ongoing pregnancies. There were some false positives, meaning women who were testing on their own would have needed to attend for an ultrasound.
The symptom checklist didn’t fare so well on its own and may not have been a useful addition to the pregnancy test, but our study was not powered to test this with a high degree of confidence.
CTU: How useful are your findings to medication abortion obtained through telemedicine? What do they suggest for the convenience of future abortion care being more self-managed than in the United States and other countries?
Lohr: Our findings suggest that using a low-sensitivity pregnancy test and checklist is effective for assessing medical abortion outcome up to 10 weeks of gestation. The model reduces the burden on women and services from requiring in-person attendance for an ultrasound or examination. We have been using pregnancy tests with either self-assessment or a call with a nurse or midwife as a means of ascertaining medical abortion outcome in Britain for many years now.
Remote or self-assessment is welcome by most, but some people would prefer or will need an in-person check, so this needs to be considered when carrying out service planning.
CTU: Many people predict abortion access will end for half of American women by 2023. Is it possible that self-managed abortion care, coupled with ordering the medication from overseas sources, could be one answer for at least some women living in areas where in-person abortion care is impossible?
Lohr: Self-management of abortion has been shown to be highly effective, to have a low complication rate, and to be very acceptable to women, but it is not a model of care every woman wants or can have. It is essential that abortion rights and choices are protected so that accessible, patient-centered services can be delivered and received.
REFERENCES
- Whitehouse KC, Shochet T, Lohr PA. Efficacy of a low-sensitivity urine pregnancy test for identifying ongoing pregnancy after medication abortion at 64 to 70 days of gestation. Contraception 2022;S0010-7824(22)00052-X.
- Quadratech Diagnostics. Check4-hCG(hl) (Mid-stream low sensitivity hCG home test for Termination of Pregnancy (TOP) 1000 mIU/mL at 5 min).
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