UCSF Study Shows Medication Abortion Without Ultrasound to Be Safe
Medication abortion patients who receive pills by mail without first getting an ultrasound do just as well as those who are examined and given the drugs in person, new research from UC San Francisco has found. The study, which appeared June 24, 2024 in JAMA, adds to evidence from UCSF’s Advancing New Standards in Reproductive Health (ANSIRH) program that using telehealth for medication abortion is safe and effective.
Testing the “No Test” Method
The researchers analyzed the experiences of 585 patients at clinics in Colorado, Illinois, Maryland, Minnesota, Virginia and Washington from May 2021 to March 2023, dividing them into three groups. Regarding the study methodology:
- The first were evaluated for eligibility for medication abortion using telehealth, underwent a patient history-based screening without ultrasound, also known as the “no-test” method, and received their medication by mail (288 patients).
- The second were assessed using the “no-test” method and received their medication in person (119 patients).
- The third underwent an ultrasound and got their medication in person (238 patients).
To summarize the distribution of the study participants:
| Patient Group | Assessment Method | Medication Delivery | Number of Patients |
|---|---|---|---|
| Group 1 | Patient history-based (No-test) | By mail | 288 |
| Group 2 | Patient history-based (No-test) | In person | 119 |
| Group 3 | Ultrasound | In person | 238 |
Safety and Effectiveness of the Regimen
All participants took the two-drug regimen of mifepristone, which blocks progesterone, a hormone that is needed to continue pregnancy, and misoprostol, which is used one to two days later to bring on contractions. The researchers found that 95% of the participants had a complete abortion without having to repeat the regimen, and the telehealth patients did as well as those who received in-person care. Serious adverse events were rare regardless of the group.
“This study adds to a growing and robust body of evidence demonstrating the effectiveness and safety of medication abortion with telehealth and mailing medications,” said Lauren J. Ralph, PhD, MPH, an associate professor of obstetrics, gynecology and reproductive sciences at UCSF and first author of the study. She further noted that “patient history-based models of medication abortion care without ultrasound and via telehealth offer a safe, effective and urgently needed way to overcome logistical and geographic obstacles to accessing abortion today.”
Context and Access to Care
Medication abortion now accounts for about two-thirds of all abortions in the U.S. health care system. These guidelines have enabled the provision of medication abortion via telehealth, which has improved access to care in recent years. Medication abortion is approved for use in people up to 10 weeks (70 days) of pregnancy and Ralph said patients can report enough information about their history to assess how far along they are in pregnancy without an ultrasound.
“The science is clear that telehealth evaluation and pharmacy dispensing of abortion pills is safe and effective,” said ANSIRH’s director, Daniel Grossman, MD, a UCSF professor of obstetrics, gynecology and reproductive sciences. Research confirms that restrictions were not necessary, and as Dr. Ralph concluded, “These models of care that rely on no-test telehealth screening and mailing medications are as effective as in-person care with ultrasound and should be offered to all pregnant people.”