Expert: Doctor Early Options - 6/21/2008

Question
Recently a friend of mine took the medical abortion method at a planned parenthood center in San Diego (she took it 8 weeks in). She claims to have experienced no bleeding at all since taking the drug and feels that her stomach is still slightly large, yet on her follow-up visit to the center they only offered a pee-test, which reported a negative pregnancy. She said that she told them there was no bleeding or cramping and asked why her stomach might be slightly large, and they said that sometimes there is no bleeding or cramping and that the stomach is the result of her possibly eating too much and pretty much tried to rush her out.
They said they'd only do an ultrasound to be sure it worked if she paid another 200 dollars -- and this is after already paying 500 dollars for the medical abortion option, and she cannot afford this; so my question is this:
a) Is a pee-test after having a medical abortion reliable enough despite the fact there was no bleeding at all after taking the drug? What're the statistical chances of it giving a false negative 9 weeks in (one week after taking the abortion pill)?
b) If not so, would a post-pee-test a week later showing up negative be enough to be certain?
c) If still not, what options should she pursue?
They said to call back after another month and a half of not having a period, but I fear that if she is still pregnant by this time, that it will either be too late to have a medical abortion, or if not it will be very hard to find a doctor that will and most definitely be far too expensive, and will result in a potentially seriously deformed baby being born.
Any advice would be greatly appreciated.
Thank you

Answer
Dear Ben,
This is a very unusual story.  I have been offering the abortion pill for over a decade and have never had a patient who did not bleed at all - especially at 8 weeks.  The other odd result is a negative urine test.  Normally, the test typically does not turn negative until 2-4 weeks after a medical abortion at 8 weeks.  Even at 6 weeks, it usually takes at least 2 weeks to become negative.  
There are a few possible scenarios.
1) the pill worked, but the pregnancy tissue is "stuck" in the cervix, which can cause bloating.
2) the pill hasn't worked at all and the pregnancy test is a false negative
3) she was never pregnant originally or it was not in the uterus or she was much earlier than 8 weeks (did she get an initial ultrasound? Who told her she was 8 weeks pregnant?)  
In any of these cases, I don't think she is getting the right medical care.  I think it would be best to find out what is going on.  I do know some doctors in the Planned Parenthood network in California.  I can potentially help you get the answers you need - you shouldn't have to pay more for getting the right medical care to begin with.  Why don't you call my office manager on Monday, and give her your contact information, and I will call you back and see what I can do.  
Doctor Joan
Earlyabortionoptions.com
Early Options, New York City