Use of Preabortion Ultrasonography Among Telehealth Medication Abortion Patients.

Background: Since 2020, some clinicians have offered telehealth medication abortion care that does not require ultrasonographic screening for eligible patients. However, some telehealth medication abortion patients nonetheless obtain ultrasonography.

Objective: This study aims to understand which patients obtain ultrasonography before telehealth medication abortion, their reasons for ultrasonography, and where they obtain it.

Study design: Using data from the California Home Abortion by Telehealth (CHAT) Study, a cohort study of patients using telehealth abortion services in 2021 and 2022, participants were asked whether they had pre-abortion ultrasonographic imaging, reasons for the ultrasonography, and where they obtained it. We analyzed these responses using chi-squared tests, Fisher's exact tests, and multivariable logistic regression.

Results: Among 1,775 participants, 11% (n = 194) obtained ultrasonography before their abortion. In the multivariable model, participants who were younger, were food insecure, had a pregnancy duration of 35 days (5 weeks) or more, or were unsure of their pregnancy duration were significantly more likely to obtain pre-abortion ultrasonography. The most common reason for ultrasonography was to assess pregnancy duration (69%). Most participants obtained imaging at a clinic (41%) or at an emergency room or hospital (27%), although some obtained imaging at crisis pregnancy centers (14%). Of those who obtained ultrasonography, 8% were referred by their telehealth provider; the remainder sought ultrasonography on their own initiative.

Conclusion: Hospitals, clinics, and imaging facilities can create policies to increase the accessibility of ultrasonography for those who desire or require pre-abortion ultrasonography.