Alternatives to a routine follow-up visit for early medical abortion.

OBJECTIVE: To evaluate the ability of women and their providers to assess abortion outcome without the routine use of ultrasonography. METHODS: This multicenter trial enrolled 4,484 women seeking medical abortion at 10 clinics in the United States. Women received the standard medical abortion care with mifepristone-misoprostol in those clinics and blinded clinical assessments before follow-up ultrasonography. Data were collected prospectively on abortion outcomes, receipt of additional treatment, and clinical, laboratory, and ultrasound assessments associated with the procedure. We constructed five model algorithms for evaluating women's postabortion status, each using a different assortment of data. Four of the algorithms (algorithms 1-4) rely on data collected by the woman and on the results of the low-sensitivity pregnancy test. Algorithm 5 relies on the woman's assessment, the results of the pregnancy test, and follow-up physician assessment (sometimes including bimanual or speculum examination). RESULTS: A total of 3,054 women received medical abortion and had adequate data for evaluation. Twenty women (0.7%) had an ongoing pregnancy; 26 (0.9%) received curettage for retained tissue, empiric treatment for possible infection, or both; and 55 (1.8%) received additional uterotonics or other medical abortion-related care. Screening algorithms including patient-observed outcomes, a low-sensitivity pregnancy test, and nonsonographic clinical evaluation were as effective as sonography in identifying women who received interventions at or after the follow-up visit. CONCLUSION: Relying on women's observations, a low-sensitivity pregnancy test, and clinical examination, women and their providers can accurately assess whether follow-up care is required after medical abortion without routine ultrasonography. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00120224. LEVEL OF EVIDENCE: II.

A randomized trial of screening for relationship violence in young women.

OBJECTIVES: We conducted a randomized controlled trial of three screening approaches to assess relationship violence disclosure among young women as well as patient and provider satisfaction. METHODS: Reproductive healthcare patients (n=699) aged 15 to 24 years completed one of three approaches to violence screening, that is, basic, healthy relationship, and bidirectional. Screening was embedded in a comprehensive health history using an audio-assisted computer interview (ACASI). Afterward, the patient met with the provider, who reviewed screening results. The patient and provider independently completed an assessment of the process. RESULTS: Medical and violence screening took about 8 minutes with those in the basic screening finishing significantly more quickly. We did detect a significant difference by screening approach for recent physical violence victimization, but no other significant differences emerged between screening approaches. Although patients' or providers' satisfaction and comfort with the screening process were positive, no differences were detected. CONCLUSIONS: An approach that frames questioning within a birectional context enhances detection of recent physical victimization, and can be completed in busy reproductive healthcare setting. All screens were equally and highly regarded by participants and adequately rated by providers.