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P051Understanding medication abortion denial among a cohort of abortion clinic patients in southern california

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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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