Mate Whenua—Follow‐Up After Early Medical Abortion in New Zealand: A Randomised Controlled Trial
Michelle R. Wise, Alison Knowles, Sally Talbot, Varsha Parag, Bev Lawton, Misty Edmonds, Brittany Gibbons, Sophia Amjad, E. Jane MacDonaldABSTRACT
Objective
To evaluate self‐assessment with low sensitivity urine pregnancy test versus comparative serum bhCG in women having early medical abortion (EMA) for the outcomes of complete follow‐up and ongoing live pregnancy.
Design
Multi‐centre parallel group randomised controlled trial.
Setting
Six abortion services in Aotearoa New Zealand.
Population
Pregnant women having EMA.
Methods
Participants were randomised on a 1:1 ratio, stratified by centre, to a follow up protocol, self‐assessment, or blood tests. Chi‐squared tests, relative risks, and absolute risk differences (with 95% confidence intervals) were calculated.
Main Outcome Measures
Primary outcome was complete follow‐up (able to discuss follow‐up test result within 6 weeks). Secondary outcomes were successful abortion; contraception; complications; and additional services.
Results
There were 732 participants. More participants in the self‐assessment group had complete follow‐up compared to the blood test group (94.5% vs. 67.4%, p < 0.001; relative risk (RR) 1.41 [95% confidence interval (CI) 1.30–1.52]). More participants in the self‐assessment group had a successful EMA (89.0% vs. 81.0%, p = 0.002; RR 1.10 [95% CI: 1.03–1.17]) and more additional follow up investigations (17.3% vs. 11.1%, p = 0.017; RR 1.55 [95% CI: 1.08–2.24]). There were no differences between groups in contraception (61.0% vs. 56.0%; RR 1.09 [95% CI: 0.96–1.23]), additional health care visits (11.% vs. 10.3%; RR 1.06 [95% CI: 0.70–1.62]), community prescriptions (4.4% vs. 5.2%; RR 0.85 [95% CI: 0.44–1.63]) or complications (8.5% vs. 8.7%; RR 1.09 [95% CI: 0.96–1.23]). There was one ongoing live pregnancy detected after the first trimester.
Conclusions
The authors recommend self‐assessment after EMA for improved follow‐up. In addition to demonstrating clinical effectiveness and safety, the findings have important implications for improving reproductive health equity.
Trial Registration
Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000890639 (registered prospectively on 21/08/2023;