Research
The study, led by researchers at the University of California, San Francisco, examined the experiences of more than 6,000 patients in the months after the federal government allowed abortion pills to be mailed, from April 2021 to January 2022.
Patients used one of three telemedicine abortion organizations—Hey Jane, Abortion on Demand, or Choix—that served 20 states and Washington, DC. The study, published Thursday in Nature Medicine, ended five months before the Supreme Court’s Roe v. Wade picked up. This sparked a wave of state abortion bans and restrictions. Since then, additional telemedicine services have opened and are used by many patients who find the method more convenient, private and affordable than visiting clinics or doctors, especially when they need to travel to another state.
The services involved in the study prescribed pills to patients who were 10 weeks pregnant or younger (one service had a notice period of eight weeks) and screened patients for medical problems that would exclude them from treatment, such as ectopic pregnancies or Blood clotting disorders.
In most cases, the services’ physicians, nurses, physician assistants, and midwives were able to determine eligibility based on patients’ written or verbal information about their pregnancy and health status, without requiring them to undergo an ultrasound scan, which is logistically difficult to obtain for some patients is . If medical eligibility was unclear, patients were asked to undergo an ultrasound scan – 486 did so and were then prescribed pills, accounting for about 8 percent of the 6,034 patients who received pills in the study.
The results
Researchers reviewed the services’ medical records and were able to determine abortion outcomes for three-quarters, or 4,454, of the patients. The vast majority – 4,351 patients, or 97.7 percent – had abortions using the standard regimen: mifepristone, which stops a pregnancy from developing, followed a day or two later by misoprostol, which uses contractions to expel the tissue.
Of the remaining patients, 85 required additional measures to complete the abortion, usually with additional medication or suction in a medical facility.
81 patients visited the emergency department and 15 patients had severe complications. Ten patients were hospitalized. Six received blood transfusions, two were treated for infections and one underwent surgery for an ectopic pregnancy.
It turned out that six patients had ectopic pregnancies, which would have prevented them from taking the pills. Studies show that ectopic pregnancies cannot always be detected early, even with ultrasound.
Of the patients who went to the emergency room, 38 percent ultimately did not require treatment. Patients sometimes go to the emergency room 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 many people about their abortion,” Dr. Ushma Upadhyay, a public health scientist at UCSF and one of the study’s authors.
No patient was found to be more than 10 weeks pregnant.
Efficacy and safety rates were similar to those in several large studies of in-person medication abortions and telemedicine abortions that required ultrasound examinations. They also matched the values on the Food and Drug Administration label for mifepristone.
Researchers also found no difference in safety or effectiveness in patients who received real-time video consultations compared to those who received prescriptions based on written information sent via text message, which was the case for most patients.
Two patients asked about the “abortion pill reversal,” an unscientific theory that suggests abortions can be stopped after taking the first drug. Both were told that “there is no evidence-based reversal treatment” and were referred for urgent in-person care, the study reported.
Greater impact
Medication abortion is being challenged in a lawsuit against the FDA by abortion opponents who want to restrict mifepristone. One of the plaintiffs claims that abortion pills are dangerous. The FDA has cited overwhelming scientific evidence that the pills are safe, and two studies that abortion opponents cited 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 shipped or prescribed via telemedicine. The Supreme Court will hear arguments in the case next month. The new study results could be mentioned by those urging the court to maintain the option of telemedicine abortion.
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2024-02-15 16:00:19
www.nytimes.com