An assessment of clinical outcomes of medication abortion without pretreatment ultrasonography in Planned Parenthood, United States, 2020–2021

Objectives: Routine ultrasound before medication abortion (MAB) may create an impediment to expanding abortion access. This study examines clinical outcomes of MAB without pretreatment ultrasound evaluation at Planned Parenthood health centers in multiple states. Study design: We conducted a secondary analysis of data from 23 US-based Planned Parenthood affiliates that provided MAB without pretreatment ultrasound for eligible patients from March 2020 to December 2021. Affiliates aggregated electronic health record data from MABs at ≤77 days gestation (based on self-report of last menstrual period) without a pretreatment ultrasound (N = 18,041). Among MABs with known outcomes (N = 9821), we calculated the incidence rates and 95% confidence intervals (CI) for completed abortion, ongoing pregnancy, subsequent procedure, emergency department/hospital visits associated with MAB, ectopic pregnancies, and gestational duration greater than 77 days. Results: Among MABs with known outcomes, 96.3% had a complete abortion (95% CI = 95.9%–96.7%), and 2.0% had an ongoing pregnancy (95% CI = 1.7%–2.3%). Four percent had a subsequent procedure (95% CI = 3.6%–4.4%), and 2.3% had a documented emergency department/hospital visit (95% CI = 2.0%–2.6%). Less than 1% had a confirmed ectopic pregnancy (0.15%, 95% CI = 0.09%–0.25%) and had a gestational duration later identified to be greater than 77 days (0.13%, 95% CI = 0.05%–0.29%). Conclusions: Our calculated incidence rates of clinical outcomes align with rates from the previous literature on MAB and from the emerging literature on MAB without pretreatment ultrasonography. Findings from this analysis suggest that MAB without pretreatment ultrasound is safe and effective for eligible patients. Implications: This large US study found that medication abortion without pretreatment ultrasonography results in similar clinical outcomes to prepandemic models that include pretreatment ultrasonography. Medication abortion without a pretreatment ultrasound may be adopted by abortion providers seeking to expand options for their patients as access to abortion continues to erode.