Mate whenua: follow up after early medical abortion

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One in four women in Aotearoa New Zealand (NZ) will have an abortion during her lifetime. Recent abortion law reform, and current health care reform, on a background of a pandemic-fuelled health workforce crisis and a paradigm shift to telehealth, creates the perfect opportunity for this research project to be relevant and timely. This research will progress knowledge about abortion in a NZ context, and the findings will fill a global knowledge gap. Early medical abortion (EMA) is safe and effective; an uncommon but crucial outcome is ongoing live pregnancy. The best method of follow up after EMA to detect ongoing pregnancy is a critical research gap. Few trials compare blood or urine pregnancy tests to ultrasound scan, and no trial compares these tests to each other. Half the abortion services in NZ use comparative blood tests whilst the other half use self-assessment; services estimate that 10-20% of women having an EMA have no follow up. Primary Aim: To assess the effectiveness of self-assessment follow up compared to serial blood test follow up on the rate of lost to follow up (LFU) in women having EMA. Secondary Aims: To assess other outcomes between the two methods of follow up: • Adverse and serious adverse events • Participant satisfaction and acceptability • Health practitioner satisfaction and acceptability • Cost effectiveness Almost 5,000 women have EMA each year. By applying the principle of partnership with wahine and whanau, we anticipate greater uptake with the follow up test, better detection of the uncommon but important outcome of ongoing live pregnancy, and a reduction in unplanned follow up care. Results of this study will inform women, health practitioners and the new national EMA telehealth service about how best to follow up after EMA. Self-assessment will potentially save significant resources in health practitioner time, testing costs, and direct contact with health services.