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Abortion EarlyTASvTVSNCT03047551

Transabdominal and Transvaginal Sonography in Medical Abortion

A study testing Transabdominal sonography and Transvaginal sonography in people with Abortion Early, run by Columbia University at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The investigator will perform a multicenter, randomized controlled trial in practices that routinely use transvaginal sonography (TVS) to compare how often clinicians order additional testing prior to medical abortion after the use of either TVS or transabdominal ultrasound (TAS) in medical abortion eligibility… Read more about this study

Who is it for?
Ages 18 years and older, women onlyHealthy volunteers can take part
Conditions the study is for
Abortion Early
What is being tested?
Transabdominal sonography and Transvaginal sonography
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
634 participants
Where
2 sitesUnited States
Study dates
Jul 2016to Jun 2018
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • English- or Spanish- speaking women seeking medical abortion
  • 18 years or older
  • Women at an estimated gestational age up to 70 days from last menstrual period (LMP)

Who cannot join

  • Women under 18 years old
  • Women at an estimated gestational age greater than 70 days from LMP at enrollment

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Planned Parenthood of Northern, Central, and Southern New Jersey

    Morristown, New Jersey, 07960

  • Columbia University Medical Center

    New York, New York, 10032

Other trials in United States

About this study

Official title: Is Transabdominal Sonography Comparable to Transvaginal Sonography for Eligibility Assessment Prior to Medical Abortion? A Randomized Controlled Trial.

The investigator will perform a multicenter, randomized controlled trial in practices that routinely use transvaginal sonography (TVS) to compare how often clinicians order additional testing prior to medical abortion after the use of either TVS or transabdominal ultrasound (TAS) in medical abortion eligibility assessment. Women will be randomized to receive either TVS or TAS prior to medical abortion. We anticipate enrolling 800 patients receiving care from about 30 providers over 6-8 months.

The primary study outcome will be the proportion of women that requires additional evaluation after sonography, prior to determination of medical abortion eligibility. The second primary outcome will be patient satisfaction, determined by a patient satisfaction questionnaire utilizing a visual analog scale.

Read the detailed description

Ultrasound use in the assessment of medical abortion eligibility varies by practice site. The National Abortion Federation (NAF), the Society of Family Planning (SFP), and the World Health Organization (WHO) guidelines do not recommend routine use of sonography; however, many institutions and practices still require this as part of clinic protocol. Many clinicians routinely perform transvaginal sonography (TVS), a more invasive assessment than transabdominal ultrasound (TAS); reliance on TVS, specifically, can be cost-prohibitive due to high-level disinfection (HLD) requirements. Thus, routine US use can greatly decrease access to abortion services.

Medical abortion accounts for an increasing proportion of abortions performed in the United States; as of 2012, 20.8% of all abortions were medical abortions. Routine use of ultrasonography and particularly TVS may be a holdover secondary to its use in early clinical trials of medical abortion efficacy - its use has remained a part of many providers' clinical practice despite evidence that it is not always necessary.

This study, specifically, would be of value for the many clinicians who currently use TVS for all medical abortion patients and could support using TAS rather than TVS in a majority of these patients. The results could also provide guidance on how often practice settings without TVS and HLD would be able to provide medical abortion, and for which patients. Such settings could include primary care or rural clinics, any low volume clinics, or those where the costs and time associated with the HLD required for use of TVS prohibit or limit the provision of medical abortion. In addition, even high-volume specialty family planning clinics would benefit from a reduction in use of TVS. In the US, many providers have sonography available and use it routinely. However, even in the US, many clinics may seek to offer medical abortion without sonography, and other researchers are studying this type of approach. This proposed study will evaluate a more intermediate change in practice, primarily geared towards the large number of providers who routinely provide transvaginal ultrasound. For those providers, moving from TVS to TAS could be both cost effective and acceptable to patients.

In detail, the study will enroll patients presenting for medical abortion at multiple clinical sites. These women will undergo routine intake per usual clinical protocol, then randomized to receive either TVS or TAS. Afterwards, routine clinical care will be provided by the clinician, which can include medical abortion provision or further testing to determine eligibility. Women will complete an acceptability survey at the conclusion of the visit.

For providers, prior to participation, providers will complete a questionnaire regarding professional characteristics. Investigators will provide a training session for all providers at each site to review TAS (i.e., techniques and standardized reporting) assuming some providers have less experience with this when compared to TVS in early pregnancy. This training session will help minimize differences in TVS and TAS related to provider experience or variability in current practice. In addition, prior to participant enrollment, each clinic site will enroll 5 pilot patients, during which providers will perform only TAS to accustom providers and clinic staff to study protocols. Each clinician will perform TAS on at least 2 but no more than 5 pilot patients.

Conditions
Abortion Early
Being tested
Transabdominal sonography, Transvaginal sonography
Keywords
Abortion, induced, Ultrasonography, Health Services accessibility, Pragmatic Clinical Trial, Randomized controlled trial as topic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Transabdominal sonographyProcedure or surgery

    Also called TAS

    Ultrasound machines vary by site. At Planned Parenthood and Columbia University Medical Center, providers utilize the LOGIQ P5 ultrasound machine, manufactured by General Electric Healthcare.

  • Transvaginal sonographyProcedure or surgery

    Also called TVS

    Ultrasound machines vary by site. At Planned Parenthood and Columbia University Medical Center, providers utilize the LOGIQ P5 ultrasound machine, manufactured by General Electric Healthcare.

Study groups in NCT03047551
Study groupRoleWhat they receive
Transabdominal SonographyActive comparatorSubjects will receive transabdominal sonography using a standard ultrasound device to determine medical abortion eligibility. A transabdominal ultrasound is used to look at the pelvic organs. Gel is placed on your abdomen. Then a small, handheld unit called a transducer is gently moved around to view the pelvic organs. The transducer sound waves make a picture on the TV screen.
Receives: Procedure: Transabdominal sonography
Transvaginal SonographyActive comparatorSubjects will receive transvaginal sonography using a standard ultrasound device to determine medical abortion eligibility. Transvaginal ultrasound is an examination of the female pelvis and urogenital tract (kidneys and bladder). It differs from an abdominal ultrasound as it looks at the pelvic organs from inside the vagina.
Receives: Procedure: Transvaginal sonography

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Subjects in Each Ultrasound Group With Additional Testing

    Evaluate how often a provider orders additional testing prior to medical abortion, but after either 1) patient history and TAS or 2) patient history and TVS.

    Measured: 1 day

  2. Visual Analog Scale (VAS) Score for Patient Acceptability for Either Modality of Ultrasound

    To measure patient satisfaction after ultrasound examination, each participant will complete an acceptability questionnaire regarding the type of ultrasound she received (TVS or TAS) using a visual analog scale (VAS). The score is on a scale range of 0-100, with 0 being "unacceptable" and 100 being "acceptable." Thus, higher scores are better.

    Measured: 1 day

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Feb 2017 (estimated)
  2. Study startJul 2016
  3. Primary completionJun 2018
  4. Study completionJun 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
634 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03047551
Sponsor's protocol ID
AAAQ8722
Acronym
TASvTVS
Status last verified
Sep 2019
First submitted
24 Oct 2016
Last updated
30 Sep 2019
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Pazol K, Creanga AA, Burley KD, Jamieson DJ. Abortion surveillance - United States, 2011. MMWR Surveill Summ. 2014 Nov 28;63(11):1-41.

    PubMed 25426741
  • Pazol K, Creanga AA, Zane SB. Trends in use of medical abortion in the United States: reanalysis of surveillance data from the Centers for Disease Control and Prevention, 2001-2008. Contraception. 2012 Dec;86(6):746-51. doi: 10.1016/j.contraception.2012.05.023. Epub 2012 Jul 6.

    PubMed 22770796
  • Jordan B, Shields WC. Happy anniversary mifepristone: a decade of promise and challenges. Contraception. 2010 Sep;82(3):219-20. doi: 10.1016/j.contraception.2010.05.017. No abstract available.

    PubMed 20705148
  • Finer LB, Wei J. Effect of mifepristone on abortion access in the United States. Obstet Gynecol. 2009 Sep;114(3):623-630. doi: 10.1097/AOG.0b013e3181b2a74d.

    PubMed 19701044
  • Raymond EG, Grossman D, Wiebe E, Winikoff B. Reaching women where they are: eliminating the initial in-person medical abortion visit. Contraception. 2015 Sep;92(3):190-3. doi: 10.1016/j.contraception.2015.06.020. Epub 2015 Jun 29.

    PubMed 26134280
  • Chong E, Frye LJ, Castle J, Dean G, Kuehl L, Winikoff B. A prospective, non-randomized study of home use of mifepristone for medical abortion in the U.S. Contraception. 2015 Sep;92(3):215-9. doi: 10.1016/j.contraception.2015.06.026. Epub 2015 Jul 2.

    PubMed 26142620
  • Gold M, Chong E. If we can do it for misoprostol, why not for mifepristone? The case for taking mifepristone out of the office in medical abortion. Contraception. 2015 Sep;92(3):194-6. doi: 10.1016/j.contraception.2015.06.011. Epub 2015 Jun 18.

    PubMed 26093187
  • Grossman D, Goldstone P. Mifepristone by prescription: a dream in the United States but reality in Australia. Contraception. 2015 Sep;92(3):186-9. doi: 10.1016/j.contraception.2015.06.014. Epub 2015 Jun 19.

    PubMed 26096369
  • Harper C, Ellertson C, Winikoff B. Could American women use mifepristone-misoprostol pills safely with less medical supervision? Contraception. 2002 Feb;65(2):133-42. doi: 10.1016/s0010-7824(01)00300-6.

    PubMed 11927116
  • Foster AM, Jackson CB, LaRoche KJ, Simmonds K, Taylor D. From qualified physician to licensed health care professional: the time has come to change mifepristone's label. Contraception. 2015 Sep;92(3):200-2. doi: 10.1016/j.contraception.2015.06.022. Epub 2015 Jun 30. No abstract available.

    PubMed 26134281
  • Kopp Kallner H, Gomperts R, Salomonsson E, Johansson M, Marions L, Gemzell-Danielsson K. The efficacy, safety and acceptability of medical termination of pregnancy provided by standard care by doctors or by nurse-midwives: a randomised controlled equivalence trial. BJOG. 2015 Mar;122(4):510-7. doi: 10.1111/1471-0528.12982. Epub 2014 Jul 18.

    PubMed 25040643
  • Warriner IK, Wang D, Huong NT, Thapa K, Tamang A, Shah I, Baird DT, Meirik O. Can midlevel health-care providers administer early medical abortion as safely and effectively as doctors? A randomised controlled equivalence trial in Nepal. Lancet. 2011 Apr 2;377(9772):1155-61. doi: 10.1016/S0140-6736(10)62229-5.

    PubMed 21458058
  • Bennett IM, Baylson M, Kalkstein K, Gillespie G, Bellamy SL, Fleischman J. Early abortion in family medicine: clinical outcomes. Ann Fam Med. 2009 Nov-Dec;7(6):527-33. doi: 10.1370/afm.1051.

    PubMed 19901312
  • Prine LW, Lesnewski R. Medication abortion and family physicians' scope of practice. J Am Board Fam Pract. 2005 Jul-Aug;18(4):304-6. doi: 10.3122/jabfm.18.4.304. No abstract available.

    PubMed 15994476
  • Prine L, Shannon C, Gillespie G, Crowden WA, Fortin J, Howe M, Dzuba I. Medical abortion: outcomes in a family medicine setting. J Am Board Fam Med. 2010 Jul-Aug;23(4):509-13. doi: 10.3122/jabfm.2010.04.090229.

    PubMed 20616293

Questions about this trial

What is this clinical trial studying?

A study testing Transabdominal sonography and Transvaginal sonography in people with Abortion Early, run by Columbia University at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 30 Sep 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 30 Sep 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Subjects in Each Ultrasound Group With Additional Testing (time frame: 1 day). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03047551, which also lists 56 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Sep 2019.

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