USA – Experiences of ectopic pregnancy among people seeking telehealth abortion care

by Biggs MA, Kaller S, Grossman D, Ko J, Koenig L, Upadhyay U


Contraception 2024;134(June):


No-test telehealth medication abortion reduces or eliminates pre-abortion ultrasound and in-person testing and is proving to be as safe, acceptable, and effective as in-person care. However, ectopic pregnancy remains a primary concern about the telehealth model. Ectopic pregnancy is a rare but serious life-threatening pregnancy complication, and we lack evidence about how ectopic pregnancies are diagnosed and treated in the no-test telehealth context. Filling a notable research gap, we describe the clinical presentation and experiences of people seeking telehealth medication abortion who were subsequently suspected or confirmed to have had an ectopic pregnancy.


From June 2022 through March 2023, we recruited patients who sought medication abortion from January 2022-March 2023 at seven virtual telehealth abortion clinics in the US who were suspected or confirmed to have had an ectopic pregnancy. Clinics shared an eligibility survey link with patients with a suspected ectopic pregnancy. People who were eligible and interested in participating scheduled an interview with a researcher. Interviews were conducted over the phone, audio recorded, and transcribed and lasted approximately 45 minutes (range 35-80 minutes). We used an iterative grounded theory approach to analyze interview transcripts and identify salient themes.


We interviewed 15 people ages 21-41 living in 11 states; 14 had a confirmed ectopic pregnancy (11 located in the fallopian tube, 2 cesarean scar, and 1 unconfirmed location). People chose telehealth abortion care because of its privacy, affordability, convenience or because it was their only option. When presenting for abortion care, most had no ectopic pregnancy symptoms or risk factors. Two had spotting and one had an IUD removed earlier in the pregnancy by her primary care provider, who did not diagnose the ectopic with ultrasound and told her the pregnancy was “where it should be.” Seven never took the medications because they experienced bleeding, pain symptoms, and/or were referred for ectopic pregnancy care by the telehealth provider. One participant with symptoms chose not to take the medications because her OB/GYN who performed an ultrasound told her she was not pregnant. Among the people who took the medications, all experienced no or light bleeding after taking the medications and 4 experienced excruciating or “dull” abdominal pain leading them to seek further care. Participants perceived telehealth abortion care to sometimes facilitate earlier ectopic pregnancy treatment and perceived ectopic pregnancy care to be fragmented and to sometimes delay treatment.


Findings suggest that no-test telehealth abortion care does not delay and sometimes facilitates earlier detection and treatment of ectopic pregnancy. Reliance on ultrasound does not eliminate the risk of missed ectopic pregnancy. Fragmented care and ultrasounds that miss the ectopic pregnancy can lead to ectopic pregnancy treatment delays. Strategies are needed to address challenges experienced with fragmented care to facilitate timely diagnosis and treatment of ectopic pregnancy.