March 22, 2023
In this issue, read about a sample protocol for medication abortion with misoprostol-only as well as published research on the feasibility and acceptability of a telemedicine medication abortion service adapted for a setting with compulsory waiting periods. Also, read about early findings from our MA-ASAP pilot study, the Misoprostol or Oxytocin for Labour Induction research dissemination event in India and approval of mifepristone in Argentina.
| |
Published Research & Comment | |
Misoprostol-Only for Medication Abortion: A Sample Protocol | |
A team of experts led by Gynuity Health Projects has developed a sample protocol for medication abortion with misoprostol-only intended to serve as guidance for clinicians in the U.S. who are familiar with mifepristone and misoprostol use in early pregnancy. Informed by published data on the effectiveness and safety of misoprostol-only regimens, the recommendation is endorsed by the Society of Family Planning. The sample protocol and accompanying commentary are freely downloadable.
For anyone interested in evidence-based information on misoprostol-only for medication abortion, you can consult a compendium comprised of articles, co-authored by Gynuity Health Projects staff and colleagues, dating from 1999 to the present year.
| |
Republic of Georgia and Moldova: Medication Abortion Care via Telemedicine | |
Published research shows that a telemedicine service adapted for a setting with compulsory waiting periods for abortion was feasible and acceptable to women. Performed in the Republic of Georgia, the study examined a more patient-centered strategy involving fewer clinic trips. After in-clinic screening for eligibility, participants received a telemedicine visit during the waiting period and then a package by mail containing abortion pills and multi-level pregnancy tests for at-home use. Most (96%) of the participants contacted by phone for a follow-up consultation reported having a successful abortion that did not require further intervention.
The findings from this and an earlier study in Moldova, which informed a policy decision to incorporate telemedicine into national abortion standards, add to the body of evidence worldwide in support of telemedicine approaches as an alternative to in-person interactions for the provision of medication abortion.
| |
Comment: Abortion Bans and Their Impacts | |
In a commentary published in January, the authors from Gynuity Health Projects consider two studies, White et al. and Rader et al., which illustrate the detrimental effects of abortion bans enacted in some U.S. states. The data from the studies, the commentary says, can help prepare clinics in protective states for the increased number of out-of-state patients. It further proposes alternative strategies to in-clinic care, including remote provision and self-management, to help ensure continued abortion access.
| |
MA-ASAP: Asynchronous, Web-Based Provision of Medication Abortion | |
We completed enrollment for our MA-ASAP pilot study. Implemented at two Planned Parenthood affiliates in Colorado and Minnesota, the study enrolled 200 patients to obtain preliminary data on a method of virtual care that uses a computer-assisted platform to facilitate screening evaluation for medication abortion.
Early results show that the online platform is effective in selecting for eligibility and raised no safety concerns. Both clinicians and patients were satisfied with the care model that dispenses with real-time interactions and builds on our prior research, which demonstrated that medication abortion can be safely provided for select patients without in-person clinic visits or facility-based tests and that abortion pills can be safely delivered by mail.
| |
Misoprostol or Oxytocin for Labour Induction (MOLI) Research Dissemination at AICOG 2023 (Kolkata, India) | |
Findings from the MOLI randomized trial were positively received when presented to Indian stakeholders at the 65th All India Congress of Obstetrics & Gynaecology (AICOG 2023) in January. Conducted across three public hospitals in Nagpur, Central India, the results show that continued uterine stimulation using oral misoprostol in the augmentation phase of labor is safe and effective when compared to the standard protocol of switching to intravenous oxytocin after cervical ripening with oral misoprostol. Results were also presented to the 200-strong audience from a situational analysis undertaken in Nagpur and the surrounding area to help pinpoint gaps in labor induction resources and policies.
The highly promising findings build on prior research by the same group (University of Liverpool, Gynuity Health Projects, and Government Medical College, Nagpur), which established low-dose oral misoprostol as an optimal method for cervical ripening—a method strongly recommended by WHO.
| |
Raymond, E.G., Mark, A., Grossman, D., Beasley, A., Brandi, K., Castle, J., Creinin, M.D., Gerdts, C., Gil, L., Grant, M., Lockley, A., Perritt, J., Shochet, T., Truan, D., Upadhyay, U.D. Medication Abortion with Misoprostol-Only: A Sample Protocol. Contraception; 2023 Feb 25; doi:https://doi.org/10.1016/j.contraception.2023.109998. Article in Press.
Koenig, L.R., Raymond, E.G., Gold, M., Boraas, C.M., Kaneshiro, B., Winikoff, B., Coplon, L., Upadhyay, U.D. Mailing Abortion Pills Does Not Delay Care: A Cohort Study Comparing Mailed to In-Person Dispensing of Abortion Medications in the United States. Contraception; 2023 Feb 1: 109962. doi:10.1016/j.contraception.2023.109962. Online ahead of print.*
Shochet, T., Turok, D., Frye, L.J., Sexsmith, C.D., Gawron, L.M., Kaiser, J.E., Winikoff, B. Single Dose Letrozole and Misoprostol for Termination of Pregnancy Through 63 days’ Gestation: A Pilot Study. Contraception; December 14, 2022; Article in Press; doi:https://doi.org/10.1016/j.contraception.2022.109924
* highlighted as one of the five most important published articles from the previous four weeks in the Maternal Health Task Force’s February 13th, 2023 e-newsletter.
| |
Mifepristone Approved in Argentina | |
Welcome news! Mifepristone was approved for medication abortion in early March by Argentina’s regulatory agency. The regulator’s decision includes granting pharmacies permission to dispense the medication (in a regimen with misoprostol) and follows a landmark vote in 2020 by Argentina’s senate in favor of legalizing abortion in the first 14 weeks of pregnancy. Gynuity Health Projects provided technical support and advice to the laboratory that filed the application.
We track the approval of mifepristone throughout the world. If you become aware of registration in new countries, do let us know by writing to pubinfo@gynuity.org.
| |
Marking 20 years of Gynuity Health Projects. Help fund the next 10! | |
Know a friend or colleague who would like to receive our Newsletter? Refer them to our subscriptions page.
| | | | |