New research with data from 3,779 patients who obtained medication abortions revealed that providers could safely eliminate screening with ultrasonography and/or pelvic examination. Simply using their clinic’s history screening questions about pregnancy duration and ectopic pregnancy risk was enough to ensure safety and efficacy of medication abortions.1
“Medication abortion is used only up to a certain gestational age — 77 days — depending on the particular policy of the provider, so it’s important to determine the patient is eligible according to that criterion,” says Elizabeth Raymond, MD, MPH, study co-author and senior medical associate at Gynuity Health Project in Tacoma, WA. “Over the years, research has confirmed or has concluded that gestational duration can be detected quite well by talking to patients about their history, menstrual cycles, and so forth. For ectopic pregnancy, the person can also be evaluated with a history.”
Despite research, many providers required women to be seen in a clinic for an ultrasound or pelvic exam. These in-person exams create barriers to abortion care for people with limited time and resources, and who often need to travel long distances to see providers.
“When the COVID pandemic came along, it became important to implement physical distancing,” Raymond notes. “An ultrasound requires close contact for the provider and patients, and patients couldn’t get to clinics, or if they could, we wanted to limit transmission of this virus.”
The pandemic’s early focus on limiting visits to hospitals and doctor’s offices created an opportunity for researching the use of screening without an in-person visit.
“Right after the pandemic began, a group of abortion experts quickly put together a protocol for evaluating patients simply by getting their history without the ultrasound,” Raymond explains. “We quickly published that, and various organizations adopted versions of this. Some providers around the United States changed their policy to allow this.”
Then, Raymond and colleagues decided to collect data on patients who were given history screenings without ultrasounds or pelvic exams to ensure it is safe and effective.
Other research showing the safety and effectiveness of screening through obtaining a history was conducted outside the United States.
“We wanted to do this in the U.S.,” she says. “We recruited clinics and had 14 in our analysis that had implemented this new policy. They contributed data from all of the patients who had medication abortion without pelvic exam or ultrasound, from February 2020 to January 2021.”
Investigators assessed the method’s efficacy, defining it as the person ending a pregnancy with the initially prescribed medication and no other treatment.
“Sometimes, medication abortion doesn’t work; it’s rare, but can happen,” Raymond says.
Raymond and colleagues concluded that 95% of the people seeking a medication abortion without being screened with an ultrasound or pelvic exam completed abortion without additional intervention.
“That figure is comparable to what is published in other studies about the efficacy of screening for a medication abortion with an ultrasound and pelvic exam,” she says.
Raymond and colleagues also assessed major adverse events. They defined these as including hospitalizations, blood transfusions, or needed surgery after receiving a medication abortion.
“What we found was 0.5% had a major adverse event,” she explains. “That is slightly higher than has been reported in previous studies by patients who did get a screening ultrasound or pelvic exam, but not much. It’s a very low rate.”
All major adverse events were resolved successfully, and the patients recovered, which is reassuring, she adds.
The researchers also studied different subgroups of the patient population, including patients who received the medication abortion remotely and obtained pills in the mail. Subgroups included people who were different ages, different races, urban, rural, and who underwent abortions previously.
“Among all of these subgroups, the efficacy and safety was about the same,” Raymond says. “There was no particular effect from any one of these factors except for gestational age; medication abortion is known to be less effective the further along the pregnancy is.”
Researchers concluded the no-test approach to medication abortion is safe and effective overall and among different subgroups.
REFERENCE
- Upadhyay UD, Raymond EG, Koenig LR, et al. Outcomes and safety of history-based screening for medication abortion: A retrospective multicenter cohort study. JAMA Intern Med 2022 Mar 21. doi: 10.1001/jamainternmed.2022.0217. [Online ahead of print].
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