History-based screening for medication abortion safe and effective, reveals JAMA study

USA: History based screening for medication abortion as safe and effective as ultrasound and examination based screening, finds a new study.Medication abortion eligibility assessment based only on history was successful and safe, with either in-person administration or medicine mailing, with results comparable to reported rates of models including ultrasound or pelvic examination.

The study was published in the Journal of American Medical Association.

Ultrasonography or a pelvic examination are commonly used to determine eligibility for medication abortion. During the COVID-19 epidemic, many practitioners ceased demanding testing before medication abortion and instead assessed patients for ectopic pregnancy and pregnancy duration risk based only on history. However, few studies on the results and safety of this unique paradigm of treatment have been undertaken in the United States. As a result, Ushma D. Upadhyay and colleagues did this research. To assess the efficacy and safety of a no-test, history-based screening strategy to medication abortion therapy.

Patients obtaining a medication abortion without pre-abortion ultrasonography or pelvic examination between February 1, 2020, and January 31, 2021, at 14 independent, Planned Parenthood, academic-affiliated, and online-only clinics across the United States were included in this retrospective cohort study. Abortion medications are administered to patients in person or by mail without the use of pre-abortion ultrasound or pelvic examination. Effectiveness was defined as complete abortion after 200 g of mifepristone and up to 1600 g of misoprostol without further intervention, as well as serious abortion-related side effects such as hospitalization, major surgery, or blood transfusion.

The key findings of this study were as follow:

1. The study includes information on 3779 individuals who had legal abortions.

2. Participants in the research were racially and ethnically varied, with 870 (23.0%) Black patients, 533 (14.1%) Latinx/Hispanic patients, 1623 (42.9%) White patients, and 327 (8.7%) identifying as mixed or belonging to other racial or ethnic groups.

3. It was most people's first medicated abortion.

4. Patients were from 34 states, with 2785 (73.7%) residing in cities. The drugs were delivered in person in 2511 (66.4%) of the abortions; in the remaining 1268 (33.6%), they were sent to the patient.

5. Follow-up data were acquired for 2825 abortions (74.8%), and missing data were accounted for using multiple imputations.

6. Twelve abortions were followed by significant abortion-related adverse events in the sample, and four individuals were treated for ectopic pregnancies.

7. Follow-up revealed 9 individuals with pregnancy lengths of more than 70 days on the date mifepristone was administered who had not been recognized during screening.

8. The adjusted rate of efficacy was 94.8%. When drugs were administered in person or sent, their effectiveness was comparable.

In conclusion, this method may provide more equal access to this critical service by expanding the types of doctors and venues that provide abortion care.

Reference:

Upadhyay, U. D., Raymond, E. G., Koenig, L. R., Coplon, L., Gold, M., Kaneshiro, B., Boraas, C. M., & Winikoff, B. (2022). Outcomes and Safety of History-Based Screening for Medication Abortion. In JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2022.0217

Keywords: abortion, medication abortion therapy, screening, ultrasonography, obstetrics, pregnancy, medical history, pelvic examination, JAMA, Ushma D Upadhyay