Restrictive OB/GYN programs unlikely to include patient factors in early pregnancy loss

Key takeaways:

• Residency programs with restrictive abortion policies were less likely to use patient factors in early pregnancy loss.
• Mifepristone and office-based aspiration were used less often in more restrictive areas.

Obstetrics and gynecology residency programs at institutions and in states with abortion restrictions were less likely to incorporate patient factors when diagnosing early pregnancy loss, researchers reported.

“Residency programs that have more abortion restrictions tend to have less evidence-based care for early pregnancy loss and are less likely to incorporate patient factors when they're making a decision to diagnose and intervene on early pregnancy loss,” Aurora M. Phillips, MD, resident physician in the department of obstetrics and gynecology at Albany Medical Center, New York, told Healio. “The diagnostic criteria for early pregnancy loss are conservative, and they’re intentionally made that way to avoid intervening on a potentially viable pregnancy. ACOG recommends them, but they also recommend that you incorporate patient factors when you’re making that diagnosis and when you’re offering the interventions as well. The way that we treat pregnancy loss can overlap with the way that we also perform induced abortions.”

In this cross-sectional survey, Phillips and colleagues emailed surveys to all 296 obstetrics and gynecology residency programs in the U.S. from November 2021 to January 2022. Of all U.S. obstetrics and gynecology residency programs that were emailed a survey, 50.3% completed the survey.

The primary outcome was rigid adherence to the diagnostic guidelines and criteria and the association of adherence with restrictive institutional abortion policies. Secondary outcomes included locations of early pregnancy loss evaluation and available treatment, including mifepristone and office-based uterine aspiration.

OB/GYN residency programs that responded to the survey had similar geographic distribution and state abortion policies and were more likely to be academic programs and Ryan programs.

Results presented at the ACOG Annual Clinical & Scientific Meeting demonstrated that 33% and 27% of residency programs with restrictive state and institutional abortion laws, respectively, incorporated patient factors in early pregnancy loss diagnoses. Conversely, 79% and 88% of residency programs with nonrestrictive state and institutional abortion laws, respectively, incorporated patient factors in their diagnoses.

Researchers also observed a lower likelihood of mifepristone use for medical abortion management in programs with restrictive state and institutional abortion laws compared with programs with nonrestrictive state and institutional abortion laws (32% and 25% vs. 75% and 86%, respectively). In addition, programs with restrictive state and institutional abortion laws had a lower likelihood for office-based uterine aspiration compared with programs with nonrestrictive state and institutional abortion laws (48% and 40% vs. 68% and 81%, respectively).

“This data was collected pre-Dobbs, so obviously it’s a completely different landscape, but we did find that institutions that did not unnecessarily limit abortion beyond what their state laws allowed and institutions with Ryan programs, which encourage education and family planning and evidence-based family planning care, were able to preserve early pregnancy loss high-quality treatment, even in the face of state restrictions,” said Rachel Flink-Bochacki, MD, MPH, associate professor in the department of obstetrics and gynecology, division chief of family planning and associate program director of resident research at Albany Medical Center. “Obviously we have to follow the laws, but do not be unnecessarily restrictive in the face of law. Institutions can still do a lot, especially with pregnancy loss care, which is not theoretically the target of the law.”