General gynaecology

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

  1. H Bracken1,
  2. W Clark1,
  3. ES Lichtenberg2,
  4. SM Schweikert3,
  5. J Tanenhaus4,
  6. A Barajas3,
  7. L Alpert1,
  8. B Winikoff1

Article first published online: 23 NOV 2010

DOI: 10.1111/j.1471-0528.2010.02753.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 118, Issue 1, pages 17–23, January 2011

Additional Information

How to Cite

Bracken, H., Clark, W., Lichtenberg, E., Schweikert, S., Tanenhaus, J., Barajas, A., Alpert, L. and Winikoff, B. (2011), Alternatives to routine ultrasound for eligibility assessment prior to early termination of pregnancy with mifepristone–misoprostol. BJOG: An International Journal of Obstetrics & Gynaecology, 118: 17–23. doi: 10.1111/j.1471-0528.2010.02753.x

Author Information

  1. 1

    Gynuity Health Projects, New York, NY, USA

  2. 2

    Family Planning Associates Medical Group, Chicago, IL, USA

  3. 3

    Planned Parenthood of San Diego and Riverside Counties, San Diego, CA, USA

  4. 4

    Planned Parenthood of New York City, Inc., New York, NY, USA

*Dr H Bracken, Gynuity Health Projects, 15 East 26th Street, 8th Floor, New York, NY 10010, USA. Email hbracken@gynuity.org

Publication History

  1. Issue published online: 10 DEC 2010
  2. Article first published online: 23 NOV 2010
  3. Accepted 13 September 2010. Published Online 23 November 2010.

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Keywords:

  • Mifepristone;
  • misoprostol;
  • termination of pregnancy;
  • ultrasound

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.

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