Test or No-Test: Comparison of Medication Abortion Outcomes and Adverse Events When Forgoing Ultrasound, Laboratory Testing, and Physical Examination.

Objectives: This study aimed to compare demographics and clinical outcomes between patients who did not undergo investigations and those who underwent investigations before receiving a prescription for medication abortion (MA) during the first 6 months of the COVID-19 pandemic. Outcomes include success rates, adverse events, pathways to completion, and loss to follow-up rates.

Methods: We conducted a retrospective medical record review of 1452 patients presenting for MA between 23 March 2020 and 30 September 2020. Descriptive statistics, 2 × 2 chi-square tests, and Fisher exact tests were used to compare characteristics and outcomes between groups.

Results: Of the 1307 patients who received a prescription, 895 (68.5%) were in the no-test group and 412 (31.5%) were in the test group. The success rate was 95.2%, with no significant difference between groups (94.0% and 95.8%, P = 0.194). Rates of adverse events were low, with 28 patients presenting for emergency department visits (2.1%), 62 having clinically significant retained products of conception (4.7%), 5 with heavy bleeding requiring treatment (0.4%), 16 with ongoing pregnancy (1.2%), and 3 requiring ectopic pregnancy management (0.2%). Completion of abortion was verified in 1034 patients (80.5%), and the loss to follow-up rate was 22.6%, with no difference between the groups (82.1% vs. 79.8%, P = 0.341; and 21.4% vs. 23.1%, P = 0.477; respectively).

Conclusions: We found that clinical outcomes were consistent across the 2 groups, with high success rates and low adverse event rates. Our study contributes to the growing body of evidence that allows for individualized care implementing selective use of low- and no-test MA protocols.