Study: Medication abortion without ultrasound safe

By Dennis Thompson, HealhDay News
Mifepristone is used in a regimen together with misoprostol to end a pregnancy less than 70 days in duration. Adobe Stock/HealthDay
Mifepristone is used in a regimen together with misoprostol to end a pregnancy less than 70 days in duration. Adobe Stock/HealthDay

Women don't need an ultrasound to have a safe medication abortion, a new study says.

Women who received abortion pills by mail without getting an ultrasound first did just as well as those who were examined and given the drugs in person, researchers found.


"This study adds to a growing and robust body of evidence demonstrating the effectiveness and safety of medication abortion with telehealth and mailing medications," said lead researcher Lauren Ralph, an associate professor of obstetrics, gynecology and reproductive sciences at the University of California-San Francisco.

"Patient history-based models of medication abortion care without ultrasound and via telehealth offer a safe, effective and urgently needed way to overcome logistical and geographic obstacles to accessing abortion today," Ralph added in a UCSF news release.

U.S. Food and Drug Administration guidelines that permit remote prescribing and delivery of medication abortion recently survived a Supreme Court challenge, but researchers said the availability of abortion pills remains under attack.


The Supreme Court upheld the guidelines in a narrow ruling, based on the plaintiffs not having the standing to sue.

In addition, a growing number of states have enacted abortion bans or severe restrictions after the court overturned Roe v. Wade in June 2022, making medication abortion many women's only option.

Medication abortion now accounts for about two-thirds of all abortions in the United States, researchers said in background notes. It's approved for use in women up to 10 weeks of pregnancy.

For the new study, researchers tracked the experience of 585 women who underwent medication abortions between May 2021 and March 2023. The women were treated by clinics in Colorado, Illinois, Maryland, Minnesota, Virginia and Washington.

One group of 288 women were screened via telehealth and mailed the abortion pills without undergoing an ultrasound.

A second group of 119 also were screened using telehealth but got their medication in person. A third group of 238 underwent ultrasound in a clinic and then picked up their medication in person.

About 95% of the participants had a complete abortion without having to repeat the regimen, results show.

Further, the telehealth patients did as well as those who received in-person care. Serious adverse events were rare in all groups.


The results show patients can report enough information about their medical history to assess how far along they are in pregnancy without an ultrasound, Ralph said.

"These models of care that rely on no-test telehealth screening and mailing medications are as effective as in-person care with ultrasound and should be offered to all pregnant people," Ralph said. 

The new study was published June 24 in the Journal of the American Medical Association.

This is the latest in a series of studies on medication abortion produced by UCSF's Advancing New Standards in Reproductive Health program.

In February, researchers there showed that medication abortion can be delivered safely and effectively through telehealth. Another study in May found that dispensing abortion pills through the mail works as well as requiring patients to pick them up in person.

"The science is clear that telehealth evaluation and pharmacy dispensing of abortion pills is safe and effective," said ANSIRH Director Dr. Daniel Grossman, a UCSF professor of obstetrics, gynecology and reproductive sciences and senior author of the latest study.  "Any attempt to restrict it is not based on science."

More information

Planned Parenthood has more about the abortion pill.

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