Self-determination of gestational age for early medication abortion using a history-based screening tool – LMP-SURE
Awarded 2021
Innovations in medication abortion service delivery
Courtney Kerestes, MD
University of Hawai'i

The requirement of ultrasound to determine gestational age prior to medication abortion remains a common practice and creates an access issue. Early in the COVID-19 pandemic, we began providing medication abortion without an ultrasound to patients with a reasonably sure last menstrual period (LMP) and a low risk for ectopic pregnancy. From our experience and that of others, we know that clinics struggle to effectively and efficiently determine who does not require an ultrasound prior to medication abortion. We propose a simple, patient-facing tool (LMP-SURE) for patients to self-determine if an ultrasound is necessary prior to medication abortion. We hypothesize that those who self-determine that they do not require an ultrasound will have a low probability of surpassing the gestational age limit for medication abortion. The tool will also identify those at highest risk for ectopic pregnancy who may benefit from an ultrasound. We will compare gestational age by LMP-SURE with gestational age by ultrasound both at the current ten-week FDA limit for medication abortion and up to fourteen weeks gestation, anticipating expanded gestational age limits. With a validated, history-based tool for determining gestational age, abortion providers could confidently eliminate the need for ultrasound for many patients. Patients could determine on their own if an ultrasound was necessary prior to self-managing an abortion or making an in-clinic appointment. Beyond the telemedicine implications, LMP-SURE could decrease costs, encourage the provision of medication abortion in settings where ultrasound is not available, and could be used by patients without a provider involved.