Telehealth Follow-up After Medical Management for Early Pregnancy Loss [A07]

INTRODUCTION: Remote follow-up protocols after medical abortion (MAB) are evidence-based, but telehealth follow-up after medical management of early pregnancy loss (EPL) has not been investigated. In this study, we compare feasibility of remote follow-up for EPL to remote follow-up for MAB. METHODS: We conducted a retrospective cohort study of patients initiating medical management of EPL up to 12 weeks and 6 days and MAB up to 9 weeks and 6 days with mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally between April 1 and October 17, 2020. Patients were routinely scheduled for telehealth follow-up in 1 week and home urine pregnancy test in 4 weeks. Our primary outcome was feasibility of telehealth follow-up for EPL compared with MAB patients, defined by successful follow-up per clinical protocol. Exploratory outcomes included comparative effectiveness and safety. RESULTS: Ninety patients (40 EPL, 50 MAB) were eligible for inclusion. The median gestational age was 7 weeks and 3 days for patients with EPL and 7 weeks and 0 days for patients undergoing MAB. Of patients eligible for telehealth follow-up, 17/19 (89%) with EPL and 28/30 (93%) undergoing MAB successfully followed up per protocol (P=.63). Telehealth assessments were consistent with completed abortion in 13/17 (76%) patients with EPL and 24/28 (86%) patients undergoing MAB (P=.43). All (4/4) of EPL and 4/5 of MAB patients for whom a clinic visit was subsequently recommended completed this visit. Of these, 1/4 with EPL and 2/4 undergoing MAB required uterine aspiration. Among those with telehealth assessments consistent with completed abortion, neither group had documented complications within 30 days. CONCLUSION: Telehealth follow-up is a feasible alternative to in-person assessment after medical management of EPL.