At-Home Use of High-Sensitivity Urine Pregnancy Tests (HSPTs) After Medication Abortion via Telemedicine

At-home use of HSPTs did not result in a higher risk of clinical intervention after medication abortion provided via telemedicine, nor did it delay identification and management of treatment failures. It was associated with modestly more unplanned, abortion-related clinical visits. Notably, participants planning HSPT were much less likely to have a clinical visit for any reason, mainly because they did not go to a facility for the planned follow-up test. Our analysis included participants from our U.S. telemedicine medication abortion project who planned either HSPT at home three to five weeks after treatment or a facility-based test within two weeks. The key findings were presented in poster form at the National Abortion Federation’s 46th Annual Meeting.

Clinical Outcomes of Medication Abortion Using Misoprostol-Only

Medication abortion with misoprostol-only was safe and produced complete abortion in most patients with follow-up, according to an analysis of data from a U.S.-based provider organization obtained over a one-year period during the COVID-19 pandemic. There was high loss to follow-up. Abortion outcome was established for half of the 911 carafem patients who were treated with up to four repeat doses of 800mcg misoprostol every three hours using differing routes of administration: 82% had complete abortion confirmed by test or history and 9% had ongoing pregnancies detected after treatment. While a combination regimen which includes mifepristone and misoprostol is more effective, misoprostol alone is recommended as a safe and effective alternative and is commonly used where mifepristone is not available or accessible.

Self-Managed Abortion via The Internet

Self-managed abortion is a process that can be done safely and effectively with community support and without medical supervision, according to research by Gynuity Health Projects and Women Help Women. We conducted a retrospective analysis of more than 3000 people from 30 countries who had sought care over a one-year period through the latter's internet-based service to understand the demand for online medication abortion and to inform service delivery practice. An interview by Gates Open Research with authors of the research paper is available to read here.

Gestational Age Testing Using Placental Proteins

A study involving an intended-use population in the U.S. confirmed the strong ability of pregnancy-associated plasma protein-A (PAPP-A) to distinguish pregnancies above and below 71 days’ duration and validated the relationship between the placental protein and gestational age. Prior research, here and here, indicated the potential of PAPP-A to act as a screening tool for assessment of pregnancy duration before medication abortion.

We are conducting a study in conflict-affected Ukraine to evaluate a telemedicine medication abortion service delivery model that limits medically unnecessary in-person visits to health or diagnostic centers. The heightened risks and practical barriers faced by women wanting an abortion during the ongoing Russian invasion underscore the importance of having in place remote service delivery options such as this one. 

In April, we held a national dissemination meeting with partners to share the results from a similar study in Azerbaijan. Data obtained from the study add to the mounting evidence globally in support of alternative, non-traditional approaches geared towards making abortion care more convenient, less expensive, and more user friendly.

A recording of a dissemination event to present results from a randomized trial that tested oral misoprostol alone for inducing labor in women with hypertension in pregnancy in India is available to view via our YouTube channel. The recording offers a deep dive into the studies associated with this project, including a situational analysis presented by Gynuity Health Projects of current labor induction resources, practices, and guidance in the Nagpur area. Eposters highlighting findings from the situational analysis and an evaluation tool designed to understand what is important to women undergoing induction of labor for a pregnancy complicated by hypertension were on virtual display at the RCOG World Congress in June and are available to view post-event under the Hot Topics (Emerging Research/Issues) in Obstetrics rubric.

Raymond, E. G., Weaver, M. A., Shochet, T., Grant, M., Boyd, K., Koenig, L. R., Upadhyay, U. Clinical Outcomes of Medication Abortion Using Misoprostol-Only: A Retrospective Chart Review at an Abortion Provider Organization in the United States. Contraception; 2023 June 28; 110109. doi: https://doi.org/10.1016/j.contraception.2023.110109.

Anger, H., Raymond, E.G. Implications of Using Home Urine Pregnancy Tests vs. Facility-Based Tests for Assessment of Outcome Following Medication Abortion Provided via Telemedicine. Contraception 2023; Apr 21; 110055. doi: 10.1016/j.contraception.2023.110055. Online ahead of print.

Frye, L.J., Buhimschi, I.A., Raymond, E.G., Zhao, G., Winikoff B. PAPP-A as a Screening Tool for Assessment of Gestational Age Before Medication Abortion in an Intended-Use Population. Biomarkers In Medicine; 11 Apr 2023; Online ahead of print; doi: https://doi.org/10.2217/bmm-2022-0653.

Shochet, T., Pizzarossa, L.B., Larrea, S., Blum, J., Jelinska, K., Comendant, R., Sagaidac, I. Self-Managed Abortion via the Internet: Analysis of One Year of Service Delivery Data from Women Help Women. Gates Open Res; 2023 Feb 13; 7:41: doi: 10.12688/gatesopenres.14369.1. eCollection 2023.

Our resources are an accessible and credible source for the latest evidence on reproductive and maternal health. A complete listing is available here.

A year has passed since the U.S. Supreme Court handed down the Dobbs v. Jackson Women’s Health Organization decision, which ended guaranteed access to abortion established by Roe v. Wade 50 years prior. Through an ongoing partnership funded by Stanford Impact Labs, a team from Stanford and Gynuity Health Projects is testing ways to flatten barriers and ease access to abortion, with an emphasis on de-medicalization, simplification, and self-care. In a recent commentary, Stanford Impact Labs examines how people in the U.S. seeking to exercise their reproductive autonomy safely and legally can be most equitably served in today's climate of uncertainty and shines a light on some of the innovations under investigation by REAL.