Self-administered Follow-up Using a Low-sensitivity Pregnancy Test after Medical Abortion: Results of a Partially Randomized Patient Preference Trial.

Introduction: In Germany, follow-up after medical abortion is typically conducted via ultrasound examination. International evidence suggests that self-administered follow-up using low-sensitivity pregnancy tests may be a safe and acceptable alternative. This study assessed the effectiveness and acceptability of this approach within the German healthcare system. Methods: In this prospective, multicenter, partially randomized, patient preference study conducted in 11 German centers (March-September 2024) involving 312 women, participants with strong preferences could choose their preferred follow-up method, while all others were randomized to either self-testing or ultrasound follow-up. Follow-up was performed using a low-sensitivity pregnancy test (1000 mIU/ml) at home or by ultrasound examination in the clinic. The primary outcome was the detection of ongoing pregnancies; patient satisfaction was assessed as a secondary outcome. Results: The detection rate of ongoing pregnancies was 100% in both groups. Specificity was 92.7% in the self-testing group and 100% in the ultrasound group. Complications were rare and occurred at similar rates in both groups. Discordant cases were rare and mainly represented false-positive results with faint test lines near the cut-off; severe complications did not occur more frequently. Satisfaction with the follow-up method was slightly lower in the self-testing group (85.9%) compared to the ultrasound group (98.3%) but remained within an acceptable range. Subjective feelings of safety were high in both groups. Conclusion: Self-administered follow-up using a low-sensitivity pregnancy test is a safe and well-accepted alternative to ultrasound examination after medical abortion. It may improve access to follow-up care, particularly for women living in underserved or remote areas.