ABSTRACT
The use of medication abortion has increased significantly in the past several years, in part due to the increased adoption of telemedicine during the COVID-19 pandemic. Several leading organizations have established recommendations for the practice of providing a medication abortion without a prior pelvic examination or ultrasonogram (no-test medication abortion). Evidence demonstrates that gestational age can be accurately measured with patient screening questions and the risk of ectopic pregnancy among women seeking medication abortion is very low. Given this paradigm shift in abortion access, increasing numbers of health care professionals worldwide have adopted these practices and published their results. This systematic review aimed to summarize the efficacy and safety outcomes of medication abortion performed without prior pelvic examination or ultrasound. Ongoing and published clinical trials were identified, and randomized control trials and comparative cohort trials discussing the provision of no-test medication abortion were eligible. The primary study outcome was successful medication abortion, defined as complete abortion without the need for surgical management. Failure was thus defined as the need for surgical intervention to complete the abortion. Medication regimens, efficacy rates, complication rates, and adverse events were ed from eligible studies. A total of 21 studies were included in this review, including cases performed in over 24 countries. Ultimately, 15 studies were sufficiently homogenous in terms of design and comparator to create aggregate data with summary statistics for the primary outcome. The overall efficacy rate of no-test medication abortion was found to be 96.4% (95% confidence interval [CI], 96.096.7) in the 10,693 patients included in this review. Among pregnancies at less than 70 days' gestation (n = 8166), the efficacy rate was 95.2% (95% CI, 94.795.7). The rate of surgical intervention was 4.4% (95% CI, 4.04.9), and at less than 70 days' gestation was 3.8% (95% CI, 3.34.3). The ectopic pregnancy rate was 0.06% (95% CI, 0.020.15), blood transfusion rate ranged from 0% to 0.7%, and there were no deaths reported. The results of this systematic review encompassing data on 10,693 patients showed demonstrate that no-test medication abortion is likely effective and safe. The rates of surgical evacuation and complication were comparable with the rate among those undergoing medication abortion with pretreatment ultrasound, and significantly lower than the rates seen with unsafe methods of abortion.
ABSTRACT
INTRODUCTION: The purpose of this study was to describe the implementation and results of a patient outreach project to offer teledoula services to patients choosing medication abortion in Hawai'i during the COVID-19 pandemic. METHODS: We trained medical student volunteers at John A. Burns School of Medicine (JABSOM) as abortion teledoulas to remotely provide emotional support, education, pain management, and selfadvocacy. We offered teledoula services to pregnant patients presenting for medication abortion either in person or via telemedicine appointment at a university-based, outpatient family planning clinic. The teledoulas were notified by the abortion provider when a patient was interested in the service and the assigned teledoula contacted the patient by phone or text message. We conducted initial training and outreach in February 2021 and recorded completed pairings of teledoulas and patients through July 2021. Institutional review board (IRB) committee approval was waived for the study. RESULTS: Of the 15 medical students who attended the teledoula training, 12 (80%) were interested in participating. Of the interested medical students, 100% successfully paired with patients for support. Of the 194 patients who had a medication abortion in the 5 months that this service was offered, 37 (19.1%) were interested in participating in the program and all were contacted by a teledoula via text message. Thirty-three (89%) patients responded to the text message and successfully connected with a teledoula for support during their medication abortion. CONCLUSION: A teledoula service staffed by medical student volunteers can be successfully implemented and provide remote support for patients choosing medication abortion during the COVID-19 pandemic.