Use of Preabortion Ultrasonography Among Telehealth Medication Abortion Patients

Since 2020, some clinicians have offered telehealth medication abortion care that does not require ultrasonographic screening for eligible patients. However, some telehealth medication abortion patients nonetheless obtain ultrasonography.

This study aims to understand which patients obtain ultrasonography before telehealth medication abortion, their reasons for ultrasonography, and where they obtain it.

Using data from the California Home Abortion by Telehealth (CHAT) Study, a cohort study of patients using telehealth abortion services in 2021 and 2022, participants were asked whether they had pre-abortion ultrasonographic imaging, reasons for the ultrasonography, and where they obtained it. We analyzed these responses using chi-squared tests, Fisher's exact tests, and multivariable logistic regression.

Among 1,775 participants, 11% (n = 194) obtained ultrasonography before their abortion. In the multivariable model, participants who were younger, were food insecure, had a pregnancy duration of 35 days (5 weeks) or more, or were unsure of their pregnancy duration were significantly more likely to obtain pre-abortion ultrasonography. The most common reason for ultrasonography was to assess pregnancy duration (69%). Most participants obtained imaging at a clinic (41%) or at an emergency room or hospital (27%), although some obtained imaging at crisis pregnancy centers (14%). Of those who obtained ultrasonography, 8% were referred by their telehealth provider; the remainder sought ultrasonography on their own initiative.

Hospitals, clinics, and imaging facilities can create policies to increase the accessibility of ultrasonography for those who desire or require pre-abortion ultrasonography.