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Obstetrics and Gynecology

Safety and Efficacy of Telehealth Medication Abortions in the US During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: August 24, 2021

Research Letter

Article Information and Disclosures

Ushma D. Upadhyay, PhD, MPH¹;

Leah R. Koenig, MSPH²;

Karen R. Meckstroth, MD, MPH¹

Author Affiliations

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
²Department of Epidemiology and Biostatistics, University of California, San Francisco

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Early in the COVID-19 pandemic, medication abortion, which typically includes mifepristone (ie, progesterone receptor antagonist) and misoprostol (ie, prostaglandin), gained prominence because it can be provided without physical contact. The American College of Obstetricians and Gynecologists and other professional organizations quickly endorsed telehealth and no-test abortion care.¹ These protocols omit Rh testing² and use patient history, rather than routine ultrasonography, to assess pregnancy duration and screen for ectopic pregnancy risks.³^,4

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Article Information

Accepted for Publication: June 20, 2021.

Published: August 24, 2021. doi:10.1001/jamanetworkopen.2021.22320

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Upadhyay UD et al. JAMA Network Open.

Corresponding Author: Ushma D. Upadhyay, PhD, MPH, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Ste 1100, Oakland, CA 94612 (ushma.upadhyay@ucsf.edu).

Author Contributions: Dr Upadhyay had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Upadhyay, Koenig.

Drafting of the manuscript: Upadhyay, Koenig.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Koenig.

Obtained funding: Upadhyay.

Administrative, technical, or material support: Upadhyay, Meckstroth.

Supervision: Upadhyay.

Conflict of Interest Disclosures: Dr Meckstroth reported receiving personal fees from Danco, Inc, a distributor of mifepristone, for staffing a US Food and Drug Administration–mandated expert hotline. The mifepristone used in this care was purchased from GenBioPro, not Danco. No other disclosures were reported.

Funding/Support: Dr Upadhyay and Ms Koenig were supported by grants from Jess Jacobs, the BaSe Family Fund, the Kahle/Austin Foundation, and the Preston-Werner Foundation.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Cindy Adam, NP, (Choix), for support with data acquisition, and Elizabeth Raymond, MD, MPH, (Gynuity Health Projects), for her contributions to conceptualization and study design. Neither of these contributors were compensated for their work in this study.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.