Medical abortion can be administered without ultrasound or physical exam, study finds – The Hill

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The story at a glance

  • A new study from the University of California, San Francisco has found that using a history-based, non-testing approach to medical abortion care is safe and effective.

  • This means healthcare providers do not need ultrasound technology or to perform a pelvic exam.

  • A history-based approach to screening can create more equitable access to abortion, by increasing the type of clinicians and places that offer abortion care.

Even more women could receive safe and effective prescriptions for medical abortion after a study found healthcare providers don’t need to perform an ultrasound or pelvic exam. Providers can safely rely on a patient’s medical history, eliminating the need for expensive equipment.

Researchers at the University of California, San Francisco studied about 3,700 abortion-eligible patients. Medication for abortions was provided without an ultrasound or pelvic exam, instead using a history-based, non-testing approach to medical abortion care.

The results of the study showed overwhelmingly positive results, with an effective rate of 95% for abortion drugs delivered in person and a 93% effective rate for those sent by mail. Only 12 abortions experienced an adverse event and four were treated for ectopic pregnancies.

Medical abortion consists of two pills, called mifepristone and misoprostol. The two work together to prevent a pregnancy from developing and were approved for use in the United States by the Food and Drug Administration (FDA) in 2000.

Once approved, medical abortion quickly became popular, with the Guttmacher Institute, an abortion rights research and advocacy group, finding it accounted for 54% of abortions in the United States in 2020. .

The researchers explained that a history-based approach to screening can create more equitable access to abortion, with the potential to increase the type of clinicians and locations that offer abortion care.

Traditionally, health care providers use an ultrasound to confirm a pregnancy and to confirm that it is not ectopic, a condition where pregnancy occurs outside of the uterus. Ectopic pregnancies are considered life-threatening and require emergency treatment.

When health care providers use a history-based method when screening for abortion care, they must consider two factors. The first is the date of a woman’s last menstrual cycle, confirming that she is less than 11 weeks pregnant.

“What we’ve learned from this study is that many people know the date of their last menstrual period very precisely. People keep calendars, there are so many apps today, so people are very reliable in terms of knowing their bodies and the progress of their pregnancy,” Ushma Upadhyay, associate professor at UC San Francisco and lead author of the study, told Changing America.


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The second factor that providers need to consider is a patient’s assessment of ectopic pregnancy risk. Factors such as whether a patient has had an ectopic pregnancy in the past, has pelvic inflammatory disease, or currently has an IUD (intrauterine device) would make her ineligible to receive a medical abortion through history-based screening.

The implications of Upadhyay’s study are far-reaching as it establishes reasons for not needing specialized equipment to offer medical abortion to patients, with ultrasound machines not only costing thousands of dollars, but also requiring specialized training. Importantly, as Upadhyay explained, “is that time, training, and having someone available to perform the ultrasound is another hurdle for providers.

“And for many it’s such a huge hurdle that they don’t offer medical abortion because of this misconception that an ultrasound machine is needed,” Upadhyay said.

According to Guttmacher, there are currently 11 states that require an abortion provider to perform an ultrasound on every person seeking an abortion. The institute also notes that routine ultrasounds are not considered medically necessary as a component of a first trimester abortion, stating that “the requirements appear to be a veiled attempt to impersonate the fetus and deter a person from to abort”.

Discouraging people from seeking abortions has become a national trend, as a large number of states have introduced and passed laws that restrict or prohibit abortion services, including medical abortion.

Like in South Dakota, where Gov. Krisit Noem (R) signed a bill that requires women to make three separate in-person visits to a doctor’s office to receive both doses of medical abortion, while also banning medical abortions via telemedicine.

Similar laws requiring a prescribing clinician to be in the physical presence of a patient exist in 19 other states, including Alabama, Arkansas, Arizona and more.

“All the latest evidence shows that medical abortion is extremely safe, it’s safer than Viagra, safer than Tylenol. I think these laws that specifically target medical abortion are precisely because science shows that they should be made much more accessible. They should be treated like any other medicine,” Upadhyay said.

The current wave of anti-abortion legislation is fueled by a landmark Supreme Court case – Dobbs v. Jackson Women’s Health Organization, which was taken over last year.

The case directly challenges the court’s 1973 decision in Roe v. Wade by challenging a Mississippi law that prohibits abortions after 15 weeks of pregnancy. The judges have already heard oral arguments in the case and are expected to issue their decision before the end of the court’s term in June.

Given the current conservative majority in court, the case should be a blow to abortion rights.


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Posted on April 26, 2022

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