Safety of Screening Alone for Medication Abortion
For individuals undergoing a medication abortion, screening with history alone was found to be as safe and effective as screening with ultrasonography or a pelvic exam.
Researchers conducted a retrospective cohort study of patients who had a medication abortion without receiving ultrasonography or pelvic examination before their abortion. All abortions were done at 14 clinics throughout the United States from February 2020 through January 2021. Abortion medications were dispensed to patients either in person (66.4%) or by mail (33.6%).
The study’s main outcome was the effectiveness of the abortifacients used, which were 200 μg of mifepristone and as many as 1600 μg of misoprostol. Effectiveness was defined as complete abortion without additional intervention. Other study measures were major abortion-related adverse events, defined as hospital admission, major surgery, or blood transfusion.
The study included data on 3779 patients, and for 69.5% of these patients (n=2626), the abortion was their first one. The researchers obtained follow-up data for 2825 abortions (74.8%) and used multiple imputation to account for missing data.
They found an adjusted effectiveness rate of 94.8% (95% CI, 93.6% - 95.9%) for medication abortions done after screening with history alone. The effectiveness rate was similar whether the abortifacients were dispensed in person or mailed. Twelve abortions (0.54%, 95% CI, 0.18% - 0.9%) resulted in major abortion-related adverse events, and 4 patients (0.22%, 95% CI, 0% - 0.45%) were treated for ectopic pregnancies.
“This approach may facilitate more equitable access to this essential service by increasing the types of clinicians and locations offering abortion care,” researchers concluded.
—Ellen Kurek
Reference:
Upadhyay UD, Raymond EG, Koenig LR, et al. Outcomes and safety of history-based screening for medication abortion: a retrospective multicenter cohort study. JAMA Intern Med. 2022;182(5):482-491. doi:10.1001/jamainternmed. 2022.0217