No-Test Medication Abortion

Abstract

To summarize the effectiveness and safety outcomes of medication abortion performed without prior pelvic examination or ultrasonogram ("no-test medication abortion"). DATA SOURCES:We searched the MEDLINE, Scopus, Web of Science, Cochrane (including ClinicalTrials.gov), CINAHL, Global Index Medicus, and CAB Direct databases to identify relevant studies published before April 2022 using a peer-reviewed search strategy including terms such as "medication abortion" and "ultrasonography." We contacted experts in the field for unpublished data and ongoing studies. METHODS OF STUDY SELECTION:We reviewed 2,423 studies using Colandr. We included studies if they presented clinical outcomes of medication abortion performed with mifepristone and misoprostol and without prior pelvic examination or ultrasonogram. We excluded studies with duplicate data. We abstracted successful abortion rates overall, as well as rates by gestational age through 63 days, 70 days and past 84 days. We abstracted complication rates, including the need for surgical evacuation, additional medications, blood transfusion, and ectopic pregnancy. TABULATION, INTEGRATION AND RESULTS:We included 21 studies with a total of 10,693 patients with outcome data reported. The overall efficacy of no-test medication abortion was 96.4%; 93.8% (95% CI 92.8-94.6%) through 63 days of gestation and 95.2% (95% CI 94.7-95.7%) through 70 days of gestation. The overall rate of surgical evacuation was 4.4% (95% CI 4.0-4.9), need for additional misoprostol 2.2% (95% CI 1.8-2.6), blood transfusion 0.5% (95% CI 0.3-0.6), and ectopic pregnancy 0.06% (95% CI 0.02-0.15).CONCLUSION: Medication abortion performed without prior pelvic examination or ultrasonogram is a safe and effective option for pregnancy termination.

Telemedicine Abortion

“…A multicenter retrospective cohort study reported similar effectiveness for no-test medication abortion whether medications were dispensed in-person (95.4%) or with telemedicine by mail (93.3%) 48 . These findings are also consistent with a systematic review of 21 studies of no-test medication abortion, including self-sourced, in-clinic, and telemedicine dispensing, with a cumulative efficacy of 96.4% completed abortions without surgical intervention 53 . The preponderance of evidence supports that medication abortion by telemedicine, with or without preabortion testing, is similarly effective to in-person care.…”

Remote Provision of Medication Abortion and Contraception Through Telemedicine

“…Complication rates were low as well, with 4.4% of patients requiring a uterine evacuation procedure and a 0.06% rate of ectopic pregnancy. 12…”

The evolving role of emergency medicine in family planning services

“…Data from ‘no-touch’ abortion protocols – medication abortion given without a dating ultrasound – provides insight into the frequency of complications that may be expected after SMA. In a large systematic review including over 10 000 patient outcomes, Pearlman Shapiro et al [17 ▪▪ ] found the overall rate of surgical evacuation was 4.4% (95% CI 4.0–4.9), blood transfusion 0.5% (95% CI 0.3–0.6), and ectopic pregnancy 0.06% (95% CI 0.02–0.15) in those using no-touch protocols. Although the rate of ectopic pregnancy in this population was low, emergency physicians must be aware of this potential risk and maintain a high index of suspicion when an intrauterine pregnancy was not previously confirmed.…”