Alternative approach to evaluation of efficiency of medicamental abortion in early stages
https://doi.org/10.33667/2078-5631-2019-3-25(400)-24-28
Abstract
Objective. To determine the effectiveness of alternative methods for assessing abortion using the drug method at an early date for use in the interests of patients.
The main provisions. 35 literary sources published in the MEDLINE, PubMed, and other databases were analyzed. It has been shown that the woman’s independent use of semi-quantitative or multi-level tests for determining the content of β-hCG in the urine at home, combined with telephone control by a physician, has high sensitivity and specificity in diagnosing pregnancy termination, is not inferior in terms of the effectiveness of ultrasound, and excludes the likelihood of overdiagnosis of abortion.
Conclusion. Routine clinical examination and ultrasonography are not required after medical abortion, and self-testing for β-hCG in the urine can be used to confirm the complete termination of pregnancy in the early stages.
About the Authors
G. B. Dikke
Academy of Medical Education n. a. F. I. Inozemtsev
Russian Federation
Saint Petersburg
Russian Federation
Saint Petersburg
M. K. Astapova
Academy of Medical Education n. a. F. I. Inozemtsev
Russian Federation
Saint Petersburg
Russian Federation
Saint Petersburg
Z. Kh. Uzdenova
Kabardino-Balkarian State University n. a. Kh. M. Berbekov
Russian Federation
Nalchik
Russian Federation
Nalchik
E. Yu. Shcherbatykh
‘Medicine’ Co.
Russian Federation
Moscow Region, Udelnaya
Russian Federation
Moscow Region, Udelnaya
References
1. WHO (accessed July 25, 2015). Safe abortion: technical and policy guidance for health systems. World Health Organization, Geneva; 2012. apps.who.int.
2. RCOG. Best practice in comprehensive abortion care. Best Practice Paper No. 2. June 2015. London; 2015. 14 р. www.rcog.org.uk.
3. РОАГ. Медикаментозное прерывание беременности. Клинические рекомендации (протокол лечения). Утвержден МЗ РФ 15.10.2015 № 15–4/10/2–6120. М., 2015. 35 с.
4. Fiala C. Improving medical abortion. Using mifepristone in combination with a prostaglandin analog. Stockholm, 2005. 205 р.
5. Дикке Г. Б. Медикаментозный аборт. М.: МЕДпресс-информ, 2015. 344 с.
6. McEwing RL, Anderson NG, Meates JBA, Allen RB et al. Sonographic appearances of the endometrium after termination of pregnancy in asymptomatic versus symptomatic women. JUM. 2009; 28: 579–86.
7. Bar-Hava I, Aschkenazi S, Orvieto R et al. Spectrum of normal intrauterine cavity sonographic findings after first trimester abortion. J Ultrasound Med. 2001; 20: 1277–81.
8. Providing medical abortion in low-resource settings: An Introductory Guidebook, Second Edition. Gynuity; 2009. 71 р.
9. Sawyer E, Ofuasia E, Ofili-Yebovi D, Helmy S, Gonzalez J, Jurkovic D. The value of measuring endometrial thickness and volume on transvaginal ultrasound scan for the diagnosis of incomplete miscarriage. Ultrasound Obstet Gynecol. 2007; 29: 205–9.
10. Reeves MF, Fox MC, Lohr PA, Creini MD. Endometrial thickness following medical abortion is not predictive of subsequent surgical intervention. Ultrasound Obstet Gynecol. 2009; 34: 104–9.
11. Behnamfar F, Mahdian M, Rahimi F, Samimi M. Misoprostol abortion: ultrasonography versus beta-hCG testing for verification of effectiveness. Pak J Med Sci. 2013; 29 (6): 1367–70.
12. Creinin MD. Change in serum beta-human chorionic gonadotropin after abortion with methotrexate and misoprostol. Am J Obstet Gynecol. 1996; 174 (2): 776–8.
13. Fiala C, Safar P, Bygdeman M, Gemzell-Danielsson K. Verifying the effectiveness of medical abortion; ultrasound versus hCG testing. Eur J Obstet Gynecol Reprod Biol. 2003; 109 (2): 190–5.
14. Clark W, Panton T, Hann L, Gold M. Medication abortion employing routine sequential measurements of serum hCG and sonography only when indicated. Contraception. 2007; 75 (2): 131–5.
15. El-Baradie SM, El-Said MH, Ragab WS, Elssery KM, Mahmoud M. Endometrial thickness and serum beta-hCG as predictors of the effectiveness of oral misoprostol in early pregnancy failure. J Obstet Gynaecol Can. 2008; 30 (10): 877–81.
16. Chou SY, Chen CY, Chiang HK, Chow PK, Wang CC, Hsu CS. Monitoring medical abortion using mifepristone/misoprostol combination with ultrasonogram and serum human chorionic gonadotropin. Taiwan J Obstet Gynecol. 2006; 45 (1): 48–52.
17. Dayananda I, Maurer R, Fortin J, Goldberg AB. Medical abortion follow-up with serum human chorionic gonadotropin compared with ultrasonography: a randomized controlled trial. Obstet Gynecol. 2013; 121 (3): 607–13. DOI: 10.1097/AOG.0b013e3182839fda.
18. Дикке Г. Б., Кутуева Р. К. Опыт прерывания беременности одной таблеткой мифепристона (200 мг) в комбинации с мизопростолом в амбулаторной практике женской консультации № 22 г. Санкт-Петербурга. Земский врач. 2012; 4 (15): 25–30.
19. Perriera L, Reeves M, Chen B, Hohmann H, Hayes J, Creinin M. Feasibility of telephone follow-up after medical abortion. Contraception. 2010; 81: 143–9. DOI: 10.1016/j.contraception.2009.08.008.
20. Iyengar K, Paul M, Iyengar SD, Klingberg-Allvin M et al. Self-assessment of the outcome of early medical abortion versus clinic follow-up in India: a randomised, controlled, non-inferiority trial. Lancet Glob Health. 2015; 3 (9): e537–45. DOI: 10.1016/S 2214–109X(15)00150–3.
21. Cameron S, Glasier A, Dewart H, Johnstone A, Burnside A. Telephone follow-up and self-performed urine pregnancy testing after early medical abortion: a service evaluation. Contraception. 2012; 86: 67–73. DOI: 10.1016/j.contraception.2011.11.010.
22. Platais I, Tsereteli T, Comendant R, Kurbanbekova D, Winikoff B. Acceptability and feasibility of phone follow-up with a semiquantitative urine pregnancy test after medical abortion in Moldova and Uzbekistan. Contraception. 2015; 91: 178–83. DOI: 10.1016/j.contraception.2014.11.004.
23. Blum J, Shochet T, Lynd K, Lichtenberg ES et al. Can at-home semi-quantitative pregnancy tests serve as a replacement for clinical follow-up of medical abortion: a United States study. Contraception. 2012; 86: 757–62. DOI: 10.1016/j.contraception.2012.06.005.
24. Grossman D, Berdichevsky K, Larrea F, Beltran J. Accuracy of a semi-quantitative urine pregnancy test compared to serum beta-hCG measurement: a possible screening tool for ongoing pregnancy after medical abortion. Contraception. 2007; 76: 101–4.
25. Clark W, Bracken H, Tanenhaus J, Schweikert S, Lichtenberg ES, Winikoff B. Alternatives to a routine follow-up visit for early medical abortion. Obstet Gynecol. 2010; 115 (2 Pt 1): 264–72. DOI: 10.1097/AOG.0b013e3181c996f3.
26. Grossman D, Ellertson C, Grimes D, Walker D. Routine follow-up visits after first-trimester induced abortion. Obstet Gynecol. 2004; 103: 738–45.
27. Chen MJ, Rounds KM, Creinin MD, Cansino C, Hou MY. Comparing office and telephone follow-up after medical abortion. Contraception. 2016; 94 (2): 122–6. DOI: 10.1016/j.contraception.2016.04.007.
28. Oppegaard KS, Qvigstad E, Fiala C, Heikinheimo O, Benson L, Gemzell-Danielsson K. Clinical follow-up compared with self-assessment of outcome after medical abortion: a multicentre, non-inferiority, randomised, controlled trial. Lancet. 2015; 385 (9969): 698–704. DOI: 10.1016/S0140–6736(14)61054–0.
29. Lynd K, Blum J, Ngoc NTN, Shochet T et al. Simplified medical abortion using a semi-quantitative pregnancy test for home-based follow-up. Int J Gynecol Obst. 2013; 121 (2): 144–8. DOI: 10.1016/j.ijgo.2012.11.022.
30. Constant D, Harries J, Daskilewicz K, Myer L, Gemzell-Danielsson K. Is self-assessment of medical abortion using a low-sensitivity pregnancy test combined with a checklist and phone text messages feasible in South African primary healthcare settings? A randomized trial. PLoS ONE 2017; 12 (6): e0179600. DOI: 10.1371/journal.pone.0179600.
31. Sheldon WR. Home use of urine pregnancy tests for medical abortion follow-up. The Lancet Global Health. 2015; 3 (9): 504–5. DOI: 10.1016/S2214–109X(15)00153–9.
32. Raymond EG, Shochet T, Bracken H. Low-sensitivity urine pregnancy testing to assess medical abortion outcome: A systematic review. Contraception. 2018; 98 (1): 30–35. DOI: 10.1016/j.contraception.2018.03.013.
33. Blum J, Sheldon WR, Ngoc NTN, Winikoff B et al. Randomized trial assessing home use of two pregnancy tests for determining early medical abortion outcomes at 3, 7 and 14 days after mifepristone. Contraception. 2016; 94 (2): 115–21. DOI: 10.1016/j.contraception.2016.04.001.
34. Dabash R, Shochet T, Hajri S, Chelli H et al. Self-administered multi-level pregnancy tests in simplified follow-up of medical abortion in Tunisia. BMC Women’s Health. 2016; 16: 49. DOI: 10.1186/s12905–016–0327–1.
35. Raymonda EG, Shochet T, Bluma J, Sheldona WR et al. Serial multilevel urine pregnancy testing to assess medical abortion outcome: a meta-analysis. Contraception. 2017; 95 (5): 442–448. DOI: 10.1016/j.contraception.2016.12.004.
Review
For citations:
Dikke G.B., Astapova M.K., Uzdenova Z.Kh., Shcherbatykh E.Yu. Alternative approach to evaluation of efficiency of medicamental abortion in early stages. Medical alphabet. 2019;3(25):24-28. (In Russ.) https://doi.org/10.33667/2078-5631-2019-3-25(400)-24-28
Views:
670
Email this article 