This article includes discussion of abortion that may be challenging for some readers.
March 6, 2023
By Jenyth Sullivan, Drexel University College of Medicine
Patients who undergo a medication abortion are using medications to end a pregnancy. Typically, two medications — mifepristone and misoprostol — are administered in succession. Mifepristone is a progesterone receptor antagonist that blocks the hormone necessary to maintain a pregnancy. It is given as a one-time 200 mg dose. Misoprostol is a prostaglandin analog that promotes uterine contractions to expel pregnancy tissue. This pill is typically administered in an 800 mcg dose and can be absorbed vaginally, sublingually or buccally. Repeat dosing may be recommended after four hours depending on estimated gestational age and/or whether the patient responded appropriately to the first dose (i.e., started bleeding, passing pregnancy tissue, etc.). Providers may also elect to prescribe antiemetics and/or ibuprofen to mitigate potential side effects of these medications.1
Recent data indicated that 54% of all abortions that occurred in the U.S. in 2020 were medication abortions.3 There are few characteristics of medication abortions that differ when a patient presents in person versus via telehealth. The initial consult includes confirmation of dating, review of pertinent medical history of the patient and explanation by the provider of what to expect with these medications. The telehealth method omits Rh testing and routine ultrasonography. For patients with an unsure date of last menstrual period or significant risk factors for ectopic pregnancy, in-person ultrasound may be necessary to confirm intrauterine pregnancy of less than 77 days’ duration. Receipt of the two recommended medications is often through the mail, due to restrictions surrounding the accessibility of mifepristone. Follow up is performed virtually to confirm receipt and administration of medications and desired effect of the medications, and it may include confirmation of a negative at-home pregnancy test four weeks later.1
A recent study during the COVID-19 pandemic suggested that telehealth medication abortion care is feasible, safe and efficacious. Their study included women with estimated pregnancy dating less than 70 days, with no contraindications to mifepristone or misoprostol, who completed an online form. Efficacy was defined as a complete abortion without additional interventions including aspiration, surgery, or more than 1600 mcg of misoprostol, and without a continued pregnancy. Safety was evaluated by the absence of any major adverse event including abdominal surgery, blood transfusion, hospital admission or death. Of the 110 patients evaluated, 95% had a complete abortion not requiring intervention, and there were no major adverse events reported. The 95% efficacy of the study is comparable to in-person medication abortions and reflects international data on the use of telehealth for medication abortion.2
Abortion clinics across the country have seen an increase in demand for abortion services since Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade. Despite the efficacy and safety of telehealth abortions, state laws ultimately control where, how and when these medications can be taken. State laws are often ambiguous regarding the legality of providing telehealth abortion services, further complicating the provision of these services. While it is not explicitly illegal to provide telehealth abortions from an abortion-rights protected state to those in states that have outlawed abortion, the decision to criminalize abortion at conception can make this practice risky in the currently charged political state. For many providers, fear of prosecution is enough to prevent them from providing telehealth abortions to patients out of state, even in states where they are licensed to practice.3
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