Clinical and service delivery implications of omitting ultrasound before medication abortion provided via direct-to-patient telemedicine and mail in the U.S

Holly A. Anger, Elizabeth G. Raymond, Melissa Grant, Sue Haskell, Christy Boraas, Kristina Tocce, Joey Banks, Leah Coplon, Tara Shochet, Ingrida Platais, Beverly Winikoff

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objectives: To compare outcomes among patients who did or did not have pre-abortion ultrasound or pelvic exam before obtaining medication abortion (MA) via direct-to-patient telemedicine and mail. Study design: We analyzed data from participants screened for enrollment into the TelAbortion study at five sites from March 25 to September 15, 2020. We compared participants who had preabortion ultrasound or pelvic exam (“test-MA”) to those who did not (“no-test MA”). Outcomes were: abortion not complete with pills alone (i.e., had procedure intervention or ongoing pregnancy), ongoing pregnancy separately, ectopic pregnancy, hospitalization and/or blood transfusion, and unplanned clinical encounters. We used propensity score weighting and multivariable logistic regression to adjust for baseline characteristics. Results: Our analysis included 287 participants who had no-test MA and 125 who had test-MA. Abortion was not complete with pills alone in 16of 287 (5.6%) no-test MA patients compared to 2of 123 (1.9%) test-MA patients (adjusted risk difference [aRD] = 4.3%, 95% confidence interval [CI]: 1.4%−7.1%). No ectopic pregnancies were detected. Groups did not differ regarding hospitalization and/or blood transfusion (p = 0.76) or ongoing pregnancy diagnosis (p = 0.59). Unplanned clinical encounters were more common in no-test MA patients (35of 287, 12.5%) than test-MA patients (10of 125, 8.0%, aRD = 6.7%, 95% CI: 0.5%−13.1%). Conclusions: Compared to patients who had pre-abortion ultrasound, patients who had no-test MA via telemedicine were more likely to have abortions that were not complete with pills alone and/or unplanned clinical encounters. However, both no-test and test-MA patients had similar and very low rates of ongoing pregnancy and hospitalization or blood transfusion. Implications: Omitting pre-abortion ultrasound before provision of medication abortion via telemedicine does not appear to compromise safety or result in more ongoing pregnancies. However, compared to patients who have preabortion ultrasound, patients who do not have pre-abortion tests may be more likely to seek post-treatment care and have procedural interventions.

Original languageEnglish (US)
Pages (from-to)659-665
Number of pages7
Issue number6
Early online dateJul 28 2021
StatePublished - Dec 2021
Externally publishedYes

Bibliographical note

Funding Information:
Conflict of interest : This work was supported by the Tara Health Foundation, the Lisa and Douglas Goldman Fund, and two anonymous donors. These donors had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Publisher Copyright:
© 2021


  • Medication abortion
  • Mifepristone
  • No-test medication abortion
  • Telemedicine
  • Ultrasound


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