远程医疗药物流产患者对Rh检测和Rh免疫球蛋白治疗的兴趣。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2025-02-26 DOI:10.1016/j.contraception.2025.110856

Linda J. Shin , Leah R. Koenig , Jennifer Ko , Karen Meckstroth , Ushma D. Upadhyay

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引用次数: 0

摘要

目的：尽管缺乏证据表明恒河猴（Rh）免疫球蛋白是必要的前三个月的药物流产，许多供应商要求常规Rh检测和Rh免疫球蛋白。我们试图评估寻求直接对患者进行远程医疗流产药物治疗的患者对血型、Rh免疫球蛋白的接受情况以及对Rh检测和Rh免疫球蛋白的兴趣，否则他们可能不需要前往诊所。研究设计：我们使用了加州远程医疗家庭流产（CHAT）研究的数据，该研究包括2021-2022年在20个州和华盛顿特区通过远程医疗寻求药物流产的患者。我们分析了来自两个CHAT研究样本的数据：来自3个虚拟诊所的调查数据和来自其中一个诊所的电子病历（emr）。患者被告知妊娠早期Rh致敏的风险较低，并根据需要进行检测或治疗。结果：1779名调查对象和2803名有EMR记录的患者中，知道自己血型的占51%，知道自己血型的占52%，其中rh阴性占21%，rh阴性占18%。189名Rh阴性调查参与者中，6名（0.4%）获得Rh免疫球蛋白。在EMR样本中，在1341名血型不明的患者中，3%表示有兴趣进行Rh检测，263名Rh阴性患者中有10%表示有兴趣接受Rh免疫球蛋白。结论：大多数选择远程医疗服务进行药物流产的患者选择不进行Rh检测和治疗。要求在妊娠早期流产时进行Rh检测和Rh免疫球蛋白的指南应考虑到患者兴趣低以及缺乏临床必要性。

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Interest in Rh testing and Rh immunoglobulin treatment among patients obtaining telehealth medication abortion

Objective

Despite an absence of evidence that Rhesus (Rh) immunoglobulin is necessary before first-trimester medication abortion, many providers require routine Rh testing and Rh immunoglobulin. We sought to assess knowledge of blood type, receipt of Rh immunoglobulin, and interest in Rh testing and Rh immunoglobulin among patients seeking direct-to-patient telehealth medication abortion care and who may not otherwise need to travel to a clinic.

Study design

We used data from the California Home Abortion by Telehealth (CHAT) Study, which included patients who sought medication abortion through telehealth in 20 states and Washington, D.C., in 2021–2022. We analyzed data from two CHAT study samples: survey data from three virtual clinics and electronic medical records (EMRs) obtained from one of those clinics. Patients were counseled on low risk of Rh sensitization at early pregnancy durations and referred for testing or treatment as preferred.

Results

Among 1779 survey participants and 2803 patients with EMR records, 51% and 52% respectively knew their blood type, of which 21% and 18% were Rh-negative. Among 189 Rh-negative survey participants, six (0.4%) obtained Rh immunoglobulin. In the EMR sample, among 1341 patients with unknown blood type, 3% indicated interest in Rh testing, and 10% of the 263 Rh-negative patients indicated interest in receiving Rh immunoglobulin.

Conclusions

Most patients who choose telehealth services for medication abortion opt out of Rh testing and treatment. Guidelines that mandate Rh testing and Rh immunoglobulin for first-trimester abortions should consider low patient interest alongside the lack of demonstrated clinical necessity.

Implications

There is low patient interest in Rh testing and Rh immunoglobulin treatment for first-trimester medication abortion through telehealth. There is a need for clinical guidelines to incorporate patient preferences. Guidelines that do not require Rh testing and treatment following first-trimester abortion are consistent with evidence-based patient-centered abortion care.

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来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.