No-test medication abortion safe, effective

Pregnancy termination through medication abortion without prior pelvic exam or ultrasonogram is safe and effective, according to findings of a systematic review published in Obstetrics & Gynecology.

The use of medication abortion, particularly without testing to determine gestational age or ectopic pregnancy, has been increasing in recent years. Although experts have advocated for this for years, widespread switches to telemedicine during the early COVID-19 pandemic have further increased this practice, according to study background.

“The no-test medication abortion approach eliminates significant barriers to abortion access, increases convenience for patients and health care professionals and reduces cost,” Marit Pearlman Shapiro, MD, MPH, of the department of obstetrics, gynecology and women’s health at the University of Hawaii in Honolulu, and colleagues wrote. “Before the COVID-19 pandemic, the published literature on no-test medication abortion was limited to a few small research studies and abortion provision outside the United States. In the context of changing practices due to COVID-19, increasing numbers of health care professionals worldwide have adopted these innovative practices and published their results.”

Pearlman Shapiro and colleagues conducted a multi-database search and identified 21 randomized controlled trials and prospective and retrospective comparative cohort studies published before April 2022 that focused on medication abortion provided without prior pelvic examination or ultrasound. Medication abortion regimens included combination mifepristone and misoprostol, as well as misoprostol alone.

The researchers evaluated the overall success of abortion without surgical management, as well as success rates by gestational age. They also evaluated the rate of complications.

Among 10,693 patients, the overall efficacy of medication abortion was 96.4% (95% CI, 96-96.7). For 3,043 people with a gestational age of less than 63 days, 93.8% (95% CI, 92.8-94.6) of medication abortion regimens were successful. For 8,166 people with a gestational age of less than 70 days, the efficacy rate was 95.2% (95% CI, 94.7-95.7). Medication abortion was successful in 83.8% (95% CI, 80-87.2) of the 432 pregnancies at more than 84 days of gestation.

The rate of complications was low, with the overall rate of surgical evacuation being 4.4% (95% CI, 4-4.9). There were only five ectopic pregnancies reported among 7,987 people with available data (0.06%; 95% CI, 0.02-0.15). There were few blood transfusions — with rates ranging from 0% to 7% — and no deaths.

“Although the studies lack uniformity in methods of reporting completed abortion, this reflects the current medical practice and expands the generalizability of our outcomes,” Pearlman Shapiro and colleagues wrote. “Patients often do not return to the clinic or are lost to follow-up after medication abortions. Further, with increasing legal restrictions on abortion, we anticipate increasing numbers of abortions outside the formal health care setting.”

Moving forward, the researchers advised that both studies and policies continue to oppose barriers to no-test medication abortion.