Clinical and Service Delivery Implications of Omitting Ultrasound Before Medication Abortion Provided Via Direct-to-Patient Telemedicine and Mail
- July 27th, 2021
- Medical Abortion
- Anger, H.A., Raymond, E.G., Grant, M., Haskell, S., Boraas, C., Tocce, K., Banks, J., Coplon, L., Shochet, T., Platais, I., Winikoff, B.
Contraception; July 27, 2021; Article in Press; doi:https://doi.org/10.1016/j.contraception.2021.07.108
Objectives: To compare outcomes among patients who did or did not have pre-abortion ultrasound or pelvic exam before obtaining medication abortion (MA) via direct-to-patient telemedicine and mail.
Study Design: We analyzed data from participants screened for enrollment into the TelAbortion study at five sites from March 25-September 15, 2020. We compared participants who had pre-abortion ultrasound or pelvic exam (“test-MA”) to those who did not (“no-test MA”). Outcomes were: abortion not complete with pills alone (i.e. had procedure intervention or ongoing pregnancy), ongoing pregnancy separately, ectopic pregnancy, hospitalization and/or blood transfusion, and unplanned clinical encounters. We used propensity score weighting and multivariable logistic regression to adjust for baseline characteristics.
Results: Our analysis included 287 participants who had no-test MA and 125 who had test-MA. Abortion was not complete with pills alone in 16/287 (5.6%) no-test MA patients compared to 2/123 (1.9%) test-MA patients (adjusted risk difference [aRD]=4.3%, 95% confidence interval [CI]: 1.4-7.1%). No ectopic pregnancies were detected. Groups did not differ regarding hospitalization and/or blood transfusion (p=0.76) or ongoing pregnancy diagnosis (p=0.59). Unplanned clinical encounters were more common in no-test MA patients (35/287, 12.5%) than test-MA patients (10/125, 8.0%, aRD=6.7%, 95% CI: 0.5-13.1%).
Conclusions: Compared to patients who had pre-abortion ultrasound, patients who had no-test MA via telemedicine were more likely to have abortions that were not complete with pills alone and/or unplanned clinical encounters. However, both no-test and test-MA patients had similar and very low rates of ongoing pregnancy and hospitalization or blood transfusion.
Implications: Omitting pre-abortion ultrasound before provision of medication abortion via telemedicine does not appear to compromise safety or result in more ongoing pregnancies. However, compared to patients who have pre-abortion ultrasound, patients who do not have pre-abortion tests may be more likely to seek post-treatment care and have procedural interventions.