Outcomes and Safety of History-Based Screening for Medication Abortion

• DOI: 10.1001/jamainternmed.2022.0217
• Publication Date: 2022-03-21T15:36:24Z
• Authors: Ushma D. Upadhyay; Elizabeth G. Raymond; Leah R. Koenig; Leah Coplon; Marji Gold; Bliss Kaneshiro; Christy M. Boraas; Beverly Winikoff
• Keywords: Medical abortion; Pelvic examination; Medical record

<h3>Importance</h3> Screening for medication abortion eligibility typically includes ultrasonography or pelvic examination. To reduce physical contact during the COVID-19 pandemic, many clinicians stopped requiring tests before and instead screened patients pregnancy duration ectopic risk by history alone. However, few US-based studies have been conducted on outcomes safety of this novel model care. <h3>Objective</h3> evaluate a history-based screening, no-test approach to <h3>Design, Setting, Participants</h3> This retrospective cohort study included obtaining without preabortion examination between February 1, 2020, January 31, 2021, at 14 independent, Planned Parenthood, academic-affiliated, online-only clinics throughout US. <h3>Exposures</h3> Medications provided dispensed in person mail. <h3>Main Outcomes Measures</h3> Effectiveness, defined as complete after 200 μg mifepristone up 1600 misoprostol additional intervention, major abortion-related adverse events, hospital admission, surgery, blood transfusion. <h3>Results</h3> The data 3779 with eligible abortions. participants were racially ethnically diverse 870 (23.0%) Black patients, 533 (14.1%) Latinx/Hispanic 1623 (42.9%) White 327 (8.7%) who identified multiracial other racial ethnic groups. For most (2626 [69.5%]), it was their first abortion. Patients lived 34 states, 2785 (73.7%) urban areas. In 2511 (66.4%) abortions, medications person; 1268 (33.6%), they mailed patient. Follow-up obtained 2825 abortions (74.8%), multiple imputation used account missing data. Across sample, 12 (0.54%; 95% CI, 0.18%-0.90%) followed 4 (0.22%; 0.00%-0.45%) treated pregnancies. 9 (0.40%; 0.00%-0.84%) had durations greater than 70 days date that not screening. adjusted effectiveness rate 94.8% (95% 93.6%-95.9%). Effectiveness similar when (95.4%; 94.1%-96.7%) (93.3%; 90.7%-95.9%). <h3>Conclusions Relevance</h3> study, screening alone effective safe either in-person dispensing mailing medications, resulting published rates models involving may facilitate more equitable access essential service increasing types locations offering