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Objectives
Given the US Food and Drug Administration approval of dispensing mifepristone by mail
and an anticipated increase in self-managed abortion, we sought to evaluate a self-screening
tool to assess eligibility for a medication abortion without ultrasound.
Methods
We designed a patient self-administered five-question screening tool (LMP-SURE) that
assesses gestational age (GA) plus factors associated with misdating or ectopic pregnancy.
We recruited participants without prior ultrasound from family planning clinics in
Alaska, Hawaii, Idaho, and Utah to complete a brief survey including LMP-SURE, and
then obtained ultrasound dating by chart review. We compared GA by ultrasound with
GA by last menstrual period, if the participant met LMP-SURE criteria aligning with
not requiring an ultrasound.
Results
1,025 participants started the survey, and 781 participants were eligible and completed
it. Using the LMP-SURE tool, 64.1% met criteria for a medication abortion without
ultrasound, while 83.6% were eligible by ultrasound. Uncertainty around last menstrual
period (LMP) (13.7%) and irregular menses (13.3%) were the most common reasons LMP-SURE
recommended ultrasound. Agreement between GA by ultrasound vs. GA by LMP-SURE was
moderate (Kappa 0.714, p<0.001). The lack of agreement primarily came from the more
conservative nature of the LMP-SURE tool. Only six participants (0.8%) over 77 days’
gestation were incorrectly determined to not need an ultrasound. Five patients with
pregnancies of unknown location (0.6%) did not screen to need an ultrasound, but the
two ectopic pregnancies (0.3%) diagnosed in the sample both required ultrasound by
LMP-SURE.
Conclusions
This brief history-based screening tool can provide patients with information about
whether an ultrasound is necessary prior to medication abortion.
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Copyright
© 2022 Published by Elsevier Inc.
