Abstract
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 to September 15, 2020. We compared participants who had
preabortion 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 16of 287 (5.6%) no-test MA patients
compared to 2of 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 (35of
287, 12.5%) than test-MA patients (10of 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 preabortion ultrasound, patients who do not have pre-abortion
tests may be more likely to seek post-treatment care and have procedural interventions.
Keywords
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Article info
Publication history
Published online: July 27, 2021
Accepted:
July 14,
2021
Received in revised form:
July 12,
2021
Received:
June 1,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
