What is the best way to confirm a medication abortion is complete?

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The current standard of practice to confirm the successful completion of a medical abortion is a transvaginal ultrasound confirming expulsion of the gestation sac 1 to 2 weeks after taking medications. Protocols involving urine pregnancy tests at home with phone follow-up decrease the need for in-clinic follow-up and appear to be effective in ruling out ongoing pregnancy when compared with ultrasound (SOR: B, RCT and case series). Follow-up with serum hCG (80% decrease from pre-abortion serum level) does not increase unplanned interventions or visits when compared with ultrasound (SOR: B, RCT). It is unknown if the use of these protocols (instead of ultrasound) would lead to more complications. Deciding which method to use should be based on informed and shared decision-making.

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