Determining the Feasibility of a No-Ultrasound Screening Tool for Early Medical Abortion in Australia

In Australia, ultrasonography to confirm gestational age (GA) and pregnancy location is a routine component of early medical abortion (EMA) care. Internationally, protocols have been developed using a history-based screening tool to identify women not requiring ultrasound. This approach, now supported by Australian guidelines, aims to reduce unnecessary barriers to abortion care.

To assess the validity and accuracy of an eligibility assessment tool for no-ultrasound EMA care. Self-reported estimation of GA and risk factors for ectopic pregnancy were compared to ultrasound findings.

This was a multicentre prospective observational study. Patients aged 14 years and over attending for EMA completed a questionnaire, including estimation of GA using last menstrual period (LMP) or date of conception (DOC), if known, and identification of risk factors for ectopic pregnancy. All patients subsequently underwent routine abortion care, including ultrasound assessment, and outcomes were determined.

Of 705 patients who completed the questionnaire between 4 January 2022 and 30 August 2023, 469 were certain of their LMP or DOC (66.5%). When the screening tool was applied, 214 (30.4%) patients remained eligible for no-ultrasound care, and all these were found to have an intrauterine pregnancy. One patient had a GA over 63 days by ultrasound.

A history-based screening tool determined 30% of patients eligible for no-ultrasound EMA care. No eligible patients had an ectopic pregnancy and only one had an ultrasound confirmed GA above 63 days. Models of EMA care not requiring routine ultrasound may improve abortion access, especially for those in rural and remote areas where ultrasound availability can be challenging.