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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

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.

References
1.
American College of Obstetricians and Gynecologists. Joint statement on abortion access during the COVID-19 outbreak. Published March 18, 2020. Accessed July 14, 2021. https://www.acog.org/news/news-releases/2020/03/joint-statement-on-abortion-access-during-the-covid-19-outbreak
2.
Mark  A , Foster  AM , Grossman  D ,  et al.  Foregoing Rh testing and anti-D immunoglobulin for women presenting for early abortion: a recommendation from the National Abortion Federation’s Clinical Policies Committee.   Contraception. 2019;99(5):265-266. doi:10.1016/j.contraception.2019.02.008PubMedGoogle ScholarCrossref
3.
Raymond  EG , Grossman  D , Mark  A ,  et al.  Commentary: no-test medication abortion: a sample protocol for increasing access during a pandemic and beyond.   Contraception. 2020;101(6):361-366. doi:10.1016/j.contraception.2020.04.005PubMedGoogle ScholarCrossref
4.
Raymond  EG , Tan  YL , Comendant  R ,  et al.  Simplified medical abortion screening: a demonstration project.   Contraception. 2018;97(4):292-296. doi:10.1016/j.contraception.2017.11.005PubMedGoogle ScholarCrossref
5.
Upadhyay  UD , Desai  S , Zlidar  V ,  et al.  Incidence of emergency department visits and complications after abortion.   Obstet Gynecol. 2015;125(1):175-183. doi:10.1097/AOG.0000000000000603PubMedGoogle ScholarCrossref
6.
Aiken  A , Lohr  P , Lord  J , Ghosh  N , Starling  J .  Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study.   BJOG. 2021;128(9):1464-1474. doi:10.1111/1471-0528.16668Google ScholarCrossref
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