Contraception. 2015 Jun 8. pii: S0010-7824(15)00229

Comparison of remote and in-clinic follow-up after methotrexate/misoprostol abortion

Dunn S, Panjwani D, Gupta M, Meaney C, Morgan R and Feuerstein E


Objectives: This study compared adherence to follow-up and clinical outcomes between standard in-clinic and remote follow-up after methotrexate/misoprostol abortion.

Study design: This non-randomized trial recruited women requesting medical abortion at two sexual health clinics in Toronto, Canada. Women received methotrexate 50 mg/m2 followed 37 days later by 800 mcg of misoprostol self-administered vaginally. For day 15 follow-up participants could choose standard in-clinic follow-up with ultrasound and assessment, or remote telephone follow-up with serum hCG performed at a community laboratory and symptom check-list. Standard and remote follow-up groups were compared for adherence, defined as completing follow-up within 7 days of the scheduled time, and clinical outcomes. Characteristics associated with adherence were assessed using multivariable logistic regression.

Results: Eighty-six (67%) of 129 women chose remote follow-up. Non-adherence rates for remote (28%) and standard (23%) follow-up groups did not differ in univariate (p=0.57) or multivariable analysis (OR 1.09, 95% confidence interval 0.39-3.01). Rates of emergency/hospital visits were 3% and 9% for remote and standard groups respectively (p=0.22) and complete loss to follow was 6% and 14% in remote and standard groups (p=0.18). Non-adherent women were more likely to be undecided about their contraception (65% vs. 28%; p=0.002), and this difference persisted in the multivariable analysis.

Conclusion: Given a choice of remote or in-clinic follow-up after methotrexate/misoprostol abortion, most women chose remote follow-up. Rates of adherence to follow-up, adverse outcomes and complete loss to follow-up were similar for women choosing remote and standard follow-up.

Implications statement: Since standard and remote follow-up after methotrexate/misoprostol abortion are associated with similar adherence to follow-up and similar safety profiles, women should be offered their choice of follow-up method.