Interest in Rh testing and Rh immunoglobulin treatment among patients obtaining telehealth medication abortion

Abstract

Objective: Despite an absence of evidence that Rhesus (Rh) immunoglobulin is necessary before first-trimester medication abortion, many providers require routine Rh testing and Rh immunoglobulin. We sought to assess knowledge of blood type, receipt of Rh immunoglobulin, and interest in Rh testing and Rh immunoglobulin among patients seeking direct-to-patient telehealth medication abortion care and who may not otherwise need to travel to a clinic.

Study design: We used data from the California Home Abortion by Telehealth (CHAT) Study, which included patients who sought medication abortion through telehealth in 20 states and Washington, D.C., in 2021-2022. We analyzed data from two CHAT study samples: survey data from three virtual clinics and electronic medical records (EMRs) obtained from one of those clinics. Patients were counseled on low risk of Rh sensitization at early pregnancy durations and referred for testing or treatment as preferred.

Results: Among 1779 survey participants and 2803 patients with EMR records, 51% and 52% respectively knew their blood type, of which 21% and 18% were Rh-negative. Among 189 Rh-negative survey participants, six (0.4%) obtained Rh immunoglobulin. In the EMR sample, among 1341 patients with unknown blood type, 3% indicated interest in Rh testing, and 10% of the 263 Rh-negative patients indicated interest in receiving Rh immunoglobulin.

Conclusions: Most patients who choose telehealth services for medication abortion opt out of Rh testing and treatment. Guidelines that mandate Rh testing and Rh immunoglobulin for first-trimester abortions should consider low patient interest alongside the lack of demonstrated clinical necessity.

Implications: There is low patient interest in Rh testing and Rh immunoglobulin treatment for first-trimester medication abortion through telehealth. There is a need for clinical guidelines to incorporate patient preferences. Guidelines that do not require Rh testing and treatment following first-trimester abortion are consistent with evidence-based patient-centered abortion care.

Keywords: Blood type knowledge; Medication abortion; Rh immunoglobulin; Rh testing; Telehealth.