UCSF ultrasound study adds to growing body of abortion-medication research

A new UCSF study published Monday found no difference in outcomes between patients who received abortion medication via telehealth appointments and those who received ultrasound examinations prior to their abortions.

Medication abortion is approved for patients who are up to 10 weeks pregnant, and ultrasound exams are typically performed to assess what stage they’re at in their pregnancies before the drugs are prescribed. But more recent research has shown that they’re not necessary, said UCSF epidemiologist and associate professor Lauren Ralph, the lead author of the study.

“The body of evidence that’s out there — that includes our study — is now quite clear that getting medication abortion, using telehealth and no test models, is just as effective as getting care in person with an ultrasound,” she said.

In the two years since the Dobbs v. Jackson Women’s Health Organization decision at the U.S. Supreme Court ended the constitutional right for women to obtain abortions, the procedure has become increasingly restricted at the state level, with 14 states banning it outright and 11 others limiting it to various stages of pregnancy.

The use of medication to induce abortions has become an increasingly relied-upon method, and just this month, the Supreme Court ruled against a challenge to a federal policy change that eased access to mifepristone, an abortion drug that is used in tandem with misoprostol.

While the court’s decision was a momentary reprieve for health-care providers and abortion activists, Ralph and others in the field are worried that more challenges are inevitable.

“[The court] didn’t actually comment on the actual substance of the case, which focused on a claim that medication abortion dispensed via telehealth, or remotely where it’s not in person with the provider, was not as safe and effective as getting care by going in person to a clinic and getting an ultrasound,” she said.

“People are very accurate at self-assessing how far along they are, especially if they’re more than 10 or 11 weeks pregnant, which is when most providers will offer medication abortion,” she said.

Ralph said she hopes her latest study will provide more scientific evidence for use in future Supreme Court cases that patients using such medications and receiving them remotely are as safe and valid as going in person.

“About a fifth of abortions in the U.S. right now within the formal health-care system are provided using telehealth,” she said. “I know there’ll be future challenges.”

The study evaluated 585 patients from Colorado, Illinois, Maryland, Minnesota, Virginia and Washington from May 2021 to March 2023 who were eligible to receive medication for abortions via telehealth.

The patients were grouped into three categories: those who were screened without ultrasounds — referred to as the no-test method — and received their medication through the mail; those who went through the no-test method and received their medication in person; and those who received ultrasounds and got their medication in person.

The study found no difference in experience between the patients who received ultrasounds and those who didn’t. Of the patients studied, 95% were able to induce abortions without having to retake the medication.

Only around 1% suffered any kind of adverse events using the medication, she said, a category that included overnight hospitalizations, blood transfusions and surgery for treatment of ectopic pregnancies, which ultrasounds would not have helped identify sooner.

The study comes after Mayor London Breed’s recent announcement of a ballot measure to enshrine abortion as a protected right in San Francisco. If adopted, the measure would deny the use of city money to cooperate with prosecutions of out-of-state patients and create a fund to help those needing abortion care.

House Speaker Nancy Pelosi visited the San Francisco Planned Parenthood on Monday to voice her support for the measure.

“San Francisco is a beacon of liberty and justice for all and a public-health model to the nation in how we provide comprehensive care to our community,” Pelosi said in a statement to The Examiner on Monday. “This ballot measure will increase resources and access to care — and I am proud to endorse it. Together we will defeat the extreme Republicans’ radical assault on reproductive freedoms.”