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O08Self-determination of eligibility for early medication abortion without ultrasound using a history-based tool — lmp-sure

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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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