P087Medical management of early pregnancy in emergency departments compared to outpatient: Evaluating a covid-19 institutional policy change to increase healthcare access

Abstract

<h3>Objectives</h3> To assess the safety and efficacy of prescribing mifepristone and misoprostol for medical management of abnormal early pregnancy in emergency departments (EDs) compared to outpatient management at a complex family planning office, and to compare post-treatment follow-up. <h3>Methods</h3> We conducted a retrospective cohort study after implementing mifepristone and misoprostol prescription in three Bronx, NY EDs during the COVID-19 pandemic's first wave. All patients receiving medical management between April 1, 2020 and March 31, 2021 were reviewed. Outcomes were compared by treatment setting. Induced abortion only occurred in the outpatient setting. Treatment success was defined as pregnancy resolution after one dose of mifepristone and misoprostol. Safety outcomes included emergent interventions and blood transfusion. We assessed rates of post-treatment follow-up. <h3>Results</h3> Some 167 patients received medical management: 33 (19.8%) in the ED and 134 (80.2%) outpatient. ED patients were older (aged 30.9±6.9 vs. 28.1±5.9, p=0.02) and more likely to have Medicaid insurance (81.8% vs. 51.5%, p=0.003). Treatment success occurred for 23 (69.7%) ED and 119 (88.8%) office patients. A multivariate logistic regression adjusting for age, insurance status, and pregnancy diagnosis showed lower odds of treatment success in the ED vs. outpatient setting, but was not statistically significant (adjusted OR (aOR), 0.60; 95% CI, 0.17–2.09; p=0.42). ED safety outcomes included two emergent uterine aspirations, one uterine artery embolization, and two blood transfusions. Outpatient safety outcomes included one admission for intravenous antibiotics. Follow-up was similar: 28 (84%) ED vs 121 (90.3%) outpatients (p=0.36). <h3>Conclusions</h3> Medical management of abnormal early pregnancy with mifepristone and misoprostol in the ED is effective. Larger studies are needed to better quantify ED safety outcomes.