Clinical and Service Delivery Implications of Omitting Ultrasound Before Medication Abortion Provided Via Direct-to-Patient Telemedicine and Mail in the U.S.

Contraception; July 27, 2021; doi: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.