Abortions via telemedicine and mail-in pills are safe and effective, study finds

The study, led by researchers at the University of California, San Francisco, analyzed the experience of more than 6,000 patients in the months after the federal government began allowing mail-in abortion pills, from April 2021 to January 2021. 2022.

Patients used one of three telemedicine abortion organizations (Hey Jane, Abortion on Demand, or Choix) that served 20 states and Washington, DC. The research, published Thursday in Nature Medicine, ended five months before the Supreme Court overturned Roe v. Wade. causing a wave of state bans and restrictions on abortion. Since then, more telemedicine services have opened, which are used by many patients who find the method more convenient, private and affordable than visiting clinics or doctors, especially if they have to travel to another state.

The services in the study prescribed pills to patients who were 10 weeks pregnant or less (one service had a limit of eight weeks) and screened the patients for medical problems that would make them ineligiblesuch as ectopic pregnancies or blood clotting disorders.

In most cases, the services’ physicians, nurse practitioners, physician assistants, and midwives were able to determine eligibility from patients’ written or verbal information about their pregnancy and health, without requiring them to have ultrasounds, which are logistically difficult to obtain for some patients. . If medical eligibility was unclear, patients were asked to have ultrasounds: 486 did so and were then prescribed pills, representing about 8 percent of the 6,034 patients who received pills in the study.

Researchers reviewed the services’ medical records and were able to determine abortion outcomes for three-quarters, or 4,454, of the patients. A large majority (4,351 patients, or 97.7 percent) completed abortions with the standard regimen: mifepristone, which stops pregnancy development, followed a day or two later by misoprostol, which causes contractions to expel tissue.

Of the remaining patients, 85 needed additional measures to complete the abortion, usually with additional medication or a suction procedure at a medical facility.

Eighty-one patients visited emergency departments and 15 patients had serious complications. Ten patients were hospitalized. Six received blood transfusions, two were treated for infections and one had surgery for an ectopic pregnancy.

Six patients turned out to have ectopic pregnancies, which would have made them ineligible to receive the pills. Studies show that ectopic pregnancies cannot always be identified early, even by ultrasound.

Of patients who visited emergency departments, 38 percent ended up not needing treatment. Patients sometimes visit emergency departments because “they don’t know if what they’re experiencing is normal and sometimes they don’t have anyone to ask and they don’t want to tell too many people about their abortion,” said Dr. Ushma Upadhyay, a scientist at public health at UCSF and one of the authors of the study.

No patient was found to be more than 10 weeks pregnant.

The effectiveness and safety rates were similar to those of several large studios of in-person medical abortion and of telemedicine abortion where ultrasounds were required. They were also similar to Food and Drug Administration rates. label for mifepristone.

The researchers also found no difference in safety or effectiveness between patients who received real-time video consultations compared to those who received prescriptions based on written information they provided via text messages, which most patients did.

Two patients asked about “abortion pill reversal,” an unscientific theory that holds that abortions can stop after taking the first medication. Both were told that “evidence-based reversal treatment does not exist” and were referred to in-person urgent care, the study reported.

Medication abortion is being challenged in a lawsuit filed against the FDA by abortion opponents seeking to reduce mifepristone. One of the plaintiffs’ claims is that abortion pills are dangerous. The FDA has cited overwhelming scientific evidence that the pills are safe, and two studies that abortion opponents referenced to support their claims were recently retracted by a scientific journal editor.

In August, an appeals court said mifepristone could remain legal, but ordered significant restrictions that would prevent it from being mailed or prescribed via telemedicine. The Supreme Court will hear arguments in the case next month. The results of the new study may be cited by those urging the court to keep telemedicine abortion available.