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How long after an abortion will a pregnancy test remain positive? #905/7

How long after an abortion will a pregnancy test remain positive? I have a patient who had a postive pregnancy test 7/31 and then terminated on 8/7. She came to my office 9/4 for an IUD insertion and her pre-insertion pregnancy test is positive. Could this be residual?


As you can see, after an abortion the hCG levels remain up for as long as 60 days.  Following an abortion a positive pregnancy test may occur for as long as 60 days post abortion when the termination procedure was successful. You  may want to share the following paragraphs with your clinician as the 19th edition of our book is still not out (as of March 21, 2007)


The following two paragraphs come from the 19the edition of Contraceptive Technology.  This excellent chapter was written by Mary Fjerstad, NP and Felicia Stewart, MD.

The initial decrease in beta hCG (βhCG) after full-term delivery is quite rapid, so that an hCG level following the delivery will have dropped to less than 50 mIU within 2 weeks, and hCG will be undetectable after 3 to 4 weeks. In the case of first-trimester abortion, if hCG is clearing normally from the bloodstream as expected, the hCG level should decline steadily, halving at least every 48 hours. However, initial hCG levels are at the peak at 8 to 10 weeks LMP, as high as 150,000 mIU; therefore even 2 weeks after first-trimester abortion, the hCG levels may still be 1,500 mIU, high enough that all pregnancy tests will still be positive. hCG is likely to be detectable by sensitive tests, including commonly-used office urine test kits, for as long as 60 days after first-trimester abortion.

When patients have medication abortion, beta hCG continues to increase following mifepristone but then declines precipitously after administration of misoprostol. By the first follow-up visit 5-17 days after taking mifepristone, beta hCG levels drop to 20% of the initial value (measured on the day of mifepristone) in 98.5% of successful medication abortions. In contrast to the usual pattern of sharp drop in hCG after medication abortion, it is possible for hCG levels to have a lengthy plateau even though the patient has a clinically normal course without need for surgical intervention. Patients who require surgical intervention less than 15 days after medical abortion due to prolonged bleeding or pain generally have higher absolute and relative beta hCG values than women with normal courses whose beta hCG values drop sharply. However, there is an overlap in absolute and relative beta hCG values between patients with lengthy plateau who in the end have successful medication abortion and those who will require uterine aspiration. Beta hCG measurement is merely a supplement to the general clinical evaluation in determining whether intervention is indicated.


Key Words:  abortion, pregnancy test, positive, terminated pregnancy, IUD insertion, 19th Edition of Contraceptive Technology

Posted 9-11-2007, Updated 3-23-2008

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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