Removing the need for imaging in limited scenarios could help clear Australia’s abortion deserts.
Women with regular periods and no risk factors for ectopic pregnancy can safely have an early-term medical abortion, offering hope for women in the bush.
The new evidence was part of an international study which included Australian trial sites and was published in The New England Journal of Medicine last week.
It follows renewed focus on abortion accessibility, after hospitals in both Orange and Queanbeyan made moves to limit surgical abortion services.
On Wednesday, Federal Health Minister Mark Butler ruled out linking federal funding for public hospitals to the provision of abortion services.
The multicentre randomised control trial involved around 1500 women who were pregnant up to 42 days gestation with an unconfirmed intrauterine pregnancy on ultrasound.
Half were assigned to an immediate-start abortion, while the other half had treatment delayed until an intrauterine pregnancy was confirmed, as is standard procedure.
Women who had symptoms of an ectopic pregnancy or other pathologic pregnancy, or history of an ectopic pregnancy, were excluded from the trial.
Eligible participants in both trial arms received the WHO-recommended medical abortion protocol of 200mg oral mifepristone, followed by 800µg of misoprostol administered 24 to 48 hours later.
When it came to completing abortion, early start of medication abortion before confirmed intrauterine pregnancy was noninferior to standard protocol of waiting for a confirmed intrauterine pregnancy.
“Reasons for failed abortion differed between the two groups, with a higher incidence of surgical intervention for incomplete abortion after standard treatment and a higher incidence of ongoing pregnancy after early start,” the researchers wrote in NEJM.
Family Planning Australia ran one of the 26 trial sites, which spanned nine countries, and is currently scoping the possibility of implementing the model of care across its physical and telehealth services in 2025.
Associate medical director Dr Evonne Ong was hopeful that it would improve accessibility for women living outside of Australia’s metro areas, for whom scans can be more difficult to access.
“[In regional and remote Australia] we have fewer imaging centres trying to cater for a larger population, so wait times play a role” Dr Ong told The Medical Republic.
“It could maybe be a whole week’s wait before the next available appointment, or even two weeks wait, and by that time the person seeking an abortion might have reached the nine-week mark, making them ineligible [for medication abortion].”
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Other challenges for women living rural are the geographic distances and the additional costs associated with that, like having to take time off work, pay for childcare or pay for accommodation overnight.
“The ability to provide a prescription for medical abortion tablets without first requiring that formal ultrasound could be really powerful,” she said.
While one study with positive results was unlikely to change practice on a wider scale, Dr Ong said it helped narrow down women who make the best candidates for early medical abortion.
Women who have a history of regular periods made particularly strong candidates for early intervention because their gestation can be reliably predicted.
“If someone has a history of regular periods and their last menstrual period was six or seven weeks ago, then we can be very certain that yes, actually, that seven-week mark is an accurate indicator,” Dr Ong said.
“As opposed to someone who’s never had a regular period in their life, where having had a period seven weeks ago doesn’t necessarily mean that they could be pregnant.”
There are some doctors, the medical director acknowledged, who are already providing very early medical abortion – they are, however, “few and far between”.
“Research like this really helps boost the confidence of other doctors potentially trying [very early medical abortion],” Dr Ong said.
