Alternatives to routine ultrasound for eligibility assessment prior to early termination of pregnancy with mifepristone–misoprostol

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Abstract:

Please cite this paper as: Bracken H, Clark W, Lichtenberg E, Schweikert S, Tanenhaus J, Barajas A, Alpert L, Winikoff B. Alternatives to routine ultrasound for eligibility assessment prior to early termination of pregnancy with mifepristone–misoprostol. BJOG 2011;118:17–23. Objective 

To test the feasibility and efficacy of an approach that foregoes the routine use of ultrasound for the determination of eligibility for medical termination of pregnancy. Design 

Prospective trial. Setting 

Ten termination of pregnancy clinics in the USA. Population 

A total of 4484 women seeking termination of pregnancy with mifepristone–misoprostol. Methods 

Women provided estimates of the date of their last menstrual period and underwent pelvic bimanual and ultrasound examinations. We compared estimates of gestational age using these three methods. Main outcome measure 

Proportion of women of ≤9 weeks’ gestation by woman or provider estimate, but >9 weeks’ gestation by ultrasound. Results 

The reliance on women’s report of their last menstrual period together with physical examination to determine their eligibility for termination of pregnancy with mifepristone–misoprostol would result in few women (63/4008 or 1.6%) accepted for treatment outside the current limits of standard mifepristone–misoprostol regimens used for early termination of pregnancy (i.e. ≤63 days’ gestation on ultrasound). Conclusions 

Last menstrual period and physical examination alone, without the routine use of ultrasound, are highly effective for the determination of women’s eligibility for early termination of pregnancy with mifepristone–misoprostol.

Keywords: Mifepristone; misoprostol; termination of pregnancy; ultrasound

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1471-0528.2010.02753.x

Affiliations: 1: Gynuity Health Projects, New York, NY, USA 2: Family Planning Associates Medical Group, Chicago, IL, USA 3: Planned Parenthood of San Diego and Riverside Counties, San Diego, CA, USA 4: Planned Parenthood of New York City, Inc., New York, NY, USA

Publication date: January 1, 2011

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