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Objectives
Routine ultrasound before medication abortion may create an impediment to expanding
abortion access. This study examines clinical outcomes among medication abortion patients
without pretreatment ultrasound evaluation at Planned Parenthood health centers in
multiple states.
Methods
We conducted a secondary analysis among 23 Planned Parenthood affiliates that provided
medication abortion without pretreatment ultrasound for eligible patients from March
2020 to December 2021. Affiliates collected and aggregated electronic health record
data from 19,041 medication abortion patients at <=77 days’ gestation (based on self-report
of last menstrual period) without a pretreatment ultrasound. Among patients with follow
up (n=10,085, 53%), we calculated the incidence rates and 95% CI of the following
outcomes: completed abortion, ongoing pregnancy, surgical intervention, emergency
department and hospital admissions associated with medication abortion, and confirmed
ectopic pregnancies.
Results
Among medication abortion patients with follow-up, 96.6% had a complete abortion (95%
CI, 96.3–97.0%), and 2.0% had an ongoing pregnancy (95% CI, 1.7%–2.3%). Four percent
of medication abortion patients had a subsequent surgical procedure (4.0%, 95% CI,
3.6%–4.4%), and 2.3% had a documented emergency department/hospital admission (95%
CI, 2.0%–2.6%). About 2 in 1,000 had a confirmed ectopic pregnancy (1.7, 95% CI, 1.0–2.7
per 1,000).
Conclusions
Our calculated incidence rates of clinical outcomes align with rates from the previous
literature on medication abortion with pretreatment ultrasonography and from the emerging
literature on medication abortion without pretreatment ultrasonography. Findings from
this analysis suggest that medication abortion without pretreatment ultrasound is
safe and effective for eligible patients.
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Copyright
© 2022 Published by Elsevier Inc.
