When to Check UPT After Abortion
A urine pregnancy test (UPT) should be performed 2-4 weeks after abortion to confirm completion of the procedure, with telephone follow-up plus a self-performed low-sensitivity UPT at 2 weeks being an effective alternative to routine in-person visits for most patients. 1, 2
Timing of Follow-Up and Pregnancy Testing
Standard Timing
- Pregnancy testing should occur 2-4 weeks post-abortion to allow sufficient time for hCG levels to decline and accurately detect ongoing pregnancy 1, 2
- For medical abortion specifically, a 2-week timepoint is optimal for telephone follow-up combined with self-performed low-sensitivity UPT, demonstrating 100% sensitivity and negative predictive value for detecting ongoing pregnancies 2
Method-Specific Considerations
- Mifepristone medical abortion at ≥50 days gestation requires mandatory follow-up due to higher risk of incomplete abortion 3
- Methotrexate medical abortion also requires mandatory follow-up visits 3
- For early medical abortion (≤63 days gestation), simplified follow-up protocols are safe and effective 4, 2
Follow-Up Modalities
Telephone-Based Follow-Up (Preferred for Most Patients)
- Telephone follow-up with self-performed low-sensitivity UPT at 2 weeks is suitable as standard screening for ongoing pregnancy after early medical abortion 2
- This approach achieved 70% successful contact rate and detected all ongoing pregnancies (100% sensitivity) in a cohort of 933 women 2
- Patients who screen "positive" based on ongoing pregnancy symptoms, scant bleeding, or positive LSUP test should be scheduled for ultrasound 2
- Telephone follow-up may require more staff effort (multiple calls needed for 44-69% of patients) but results in similar outcomes to office visits 5
Office-Based Follow-Up
- Office follow-up with ultrasound at 1-2 weeks post-abortion is an alternative for patients who prefer in-person evaluation 5
- Office evaluation patients have slightly higher completion rates (94.3% vs 84.5%) but similar rates of loss to follow-up (4.8% vs 5.6%) compared to telephone follow-up 5
- Overall proportion lost to follow-up is low (approximately 5%) when patients have choice of follow-up modality 5
What the Follow-Up Should Assess
Primary Objectives
- Confirm abortion completion through pregnancy test results and symptom assessment 3, 2
- Screen for ongoing pregnancy symptoms including persistent nausea, breast tenderness, or absence of bleeding 2
- Assess bleeding pattern - normal bleeding should have occurred with clots, followed by cessation of heavy bleeding 4
Secondary Objectives (Can Be Unbundled)
- Contraception counseling and provision should be offered but not required as prerequisite for follow-up 1
- Contraception can be initiated immediately post-abortion if reasonably certain patient is not pregnant 1
- STI screening and Pap testing should not be inflexibly bundled with post-abortion care 3
Clinical Pitfalls and Important Caveats
Timing Limitations
- The natural history of severe complications (infection, unrecognized ectopic pregnancy) is inconsistent with typical follow-up visit timing, meaning routine visits may miss these conditions 3
- A negative pregnancy test alone is insufficient for definitively ruling out pregnancy due to test characteristics and timing since intercourse 1
When Mandatory In-Person Follow-Up Is Needed
- History of drug abuse is associated with non-attendance (OR=0.22), requiring more intensive follow-up planning 6
- Patients with uncertain abortion completion (minimal bleeding, persistent symptoms) require ultrasound evaluation 4, 2
- Medical abortion patients are more likely to attend follow-up (OR=3.30-3.93) compared to surgical abortion patients 6
Patient Education
- Women should be taught to recognize complications themselves rather than relying solely on scheduled visits 3
- Simple instructions about detecting complications may suffice for most patients, potentially coupled with telephone follow-up 3
- Patients should be advised to return at any time with questions or concerns 1
Contraception Initiation Post-Abortion
Immediate Initiation
- Any contraceptive method may be started immediately post-abortion if reasonably certain the patient is not pregnant 1
- The patient meets criteria for "reasonably certain not pregnant" if ≤7 days after spontaneous or induced abortion 1
- IUD placement within 48 hours of completed medical abortion (≤63 days gestation) is safe, associated with lower pain scores, and preferred by patients compared to placement at 2-4 weeks 4