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Objectives
Medication abortion is safe and effective up to 77 days’ gestation. It is unknown
how often patients who present for medication abortion do not receive one and whether
those who are ineligible for medication abortion eventually receive surgical abortion.
Methods
We performed a retrospective cohort study of patients presenting for medication abortion
at medication-abortion-only Planned Parenthood of the Pacific Southwest (PPPSW) sites
from January to December 2021. PPPSW has 15 such clinics and two that offer surgical
abortion. Patients seen at a medication-abortion-only site who were found ineligible
after intake ultrasound (>70 days’ gestation) were scheduled for an abortion at a
surgical location. Electronic medical records were reviewed to determine medication
abortion outcomes.
Results
Of 11,684 patients presenting for medication abortion at sites that only offered this
service, 2,224 (19%) did not receive a medication abortion: 1,251 (56%) had an intrauterine
pregnancy (IUP), 388 (17%) had a pregnancy of unknown location (PUL), and 116 (5%)
had a non-viable pregnancy. Among those with an IUP, 426 (34%) presented at >70 days’
gestation by ultrasound, and 223 (18%) between 71–77 days’ gestation. Of these patients,
324 (76%) went on to receive a surgical abortion (54% dilation and curettage and 22%
dilation and evacuation) after an average wait time of 10.5 days.
Conclusions
Even with a referral system in place, one-quarter of those presenting for medication
abortion with an IUP at >70 days’ gestation were lost to follow-up. Despite safety
of medication abortion for patients with PUL, many of these patients did not receive
one. Expanding medication abortion eligibility criteria by one week to 77 days’ gestation
and allowing medication abortion for PUL would expand access.
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Copyright
© 2022 Published by Elsevier Inc.
