- Design
- Multicentre, parallel-group randomised controlled trial
- Population
- 732 women having early medical abortion at six New Zealand services
- Primary outcome
- Complete follow-up within 6 weeks
- Effect
- 94.5% vs 67.4%; RR 1.41 (95% CI 1.30 to 1.52)
The Mate Whenua trial randomised 732 women having early medical abortion at six New Zealand services to follow-up by self-assessment with a low-sensitivity urine pregnancy test or by comparative serum beta-hCG.
Complete follow-up, meaning the woman was able to discuss her follow-up result within six weeks, was 94.5% with self-assessment versus 67.4% with blood tests (RR 1.41, 95% CI 1.30 to 1.52). Successful abortion was recorded more often in the self-assessment group (89.0% vs 81.0%), and additional investigations were more frequent (17.3% vs 11.1%). Complications (8.5% vs 8.7%), extra healthcare visits and contraception uptake did not differ. One ongoing pregnancy beyond the first trimester was detected.
The gap in follow-up is the result that matters: a third of women in the blood test arm did not complete follow-up, which is exactly where a continuing pregnancy or a complication can be missed. A urine test at home removes the second trip to a laboratory, which is a real barrier for women far from services or unable to take time away. Whether low-sensitivity urine tests are readily available locally is the practical question for Indian services.
- Consider offering home self-assessment with a low-sensitivity urine pregnancy test as the default follow-up after early medical abortion.
- Give clear written instructions on when to test and what a positive result means.
- Arrange a named contact route so a woman with a positive test or ongoing symptoms is seen promptly.
- Reserve serial serum beta-hCG for women with uncertain gestation, suspected ectopic or other specific concerns.
- Check that the urine test supplied is a low-sensitivity type, since a standard test may stay positive for weeks.
Why it matters
Follow-up that a third of women never complete is not a safety net, and this trial shows a simpler route catches more of them.
Don't overread it
With one continuing pregnancy detected, the trial was too small to compare how reliably each method picks up ongoing pregnancy.
The statistics, in plain English
An RR of 1.41 means women in the self-assessment arm were about 41% more likely to complete follow-up, an absolute gain of about 27 percentage points. The interval of 1.30 to 1.52 is narrow and well clear of 1, so this is a robust effect. The secondary outcomes were not what the trial was designed around, so read them as supportive rather than definitive.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for obstetrics & gynaecology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free