Article Text

Telemedicine medical abortion at home under 12 weeks’ gestation: a prospective observational cohort study during the COVID-19 pandemic
  1. John Joseph Reynolds-Wright1,2,
  2. Anne Johnstone1,2,
  3. Karen McCabe1,2,
  4. Emily Evans3,
  5. Sharon Cameron1,2
  1. 1 Queen's Medical Research Institute, University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
  2. 2 NHS Lothian, Chalmers Centre, Edinburgh, UK
  3. 3 Edinburgh Clinical Research Facility, Edinburgh, UK
  1. Correspondence to Dr John Joseph Reynolds-Wright, Queen's Medical Research Institute, University of Edinburgh MRC Centre for Reproductive Health, Edinburgh EH16 4TJ, UK; jjrw{at}doctors.org.uk

Abstract

Background In response to the COVID-19 pandemic, legislation and guidance were introduced in Scotland permitting medical abortion at home by telemedicine for pregnancies at less than 12 weeks’ gestation. Women had a telephone consultation with a clinician. Routine ultrasound was not performed. Medications and a low-sensitivity pregnancy test to confirm success of treatment were collected by or delivered to the woman, with telephone support provided as needed.

Methods A prospective cohort study of 663 women choosing medical abortion at home via the NHS Lothian telemedicine abortion service between 1 April and 9 July 2020. Interviewer-administered questionnaires were completed 4 and 14 days following treatment. Regional hospital databases were reviewed to verify abortion outcomes and complications within 6 weeks. Outcome measures included efficacy, complications and acceptability.

Results Almost all (642/663, 98.2%) the women were under 10 weeks’ gestation. For 522/663 (78.7%) women, gestation was determined using last menstrual period alone. Some 650/663 (98%) women had a complete abortion, 5 (0.8%) an ongoing pregnancy and 4 (0.6%) an incomplete abortion. No one was treated inadvertently beyond 12 weeks’ gestation, but one woman was never pregnant. One woman who had a pre-abortion ultrasound was later managed as a caesarean scar ectopic. There were two cases of haemorrhage and no severe infections. Some 123 (18.5%) women sought advice by telephone for a concern related to the abortion and 56 (8.4%) then attended a clinic for review. Most (628, 95%) women rated their care as very or somewhat acceptable.

Conclusions This model of telemedicine abortion without routine ultrasound is safe, and has high efficacy and high acceptability among women.

  • abortion
  • therapeutic
  • abortion
  • induced
  • COVID-19
  • health Services Research
  • mifepristone
  • reproductive health

Data availability statement

The original data are not available in a public repository. The corresponding author is to be contacted for the consideration of any data requests.

https://creativecommons.org/licenses/by/4.0/

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Data availability statement

The original data are not available in a public repository. The corresponding author is to be contacted for the consideration of any data requests.

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Footnotes

  • Twitter @doctorjjrw

  • Contributors JRW and STC designed the study, analysed the data and drafted the manuscript. AJ and KM contributed to questionnaire design and collected the data. EE undertook statistical analysis. All authors reviewed the final manuscript prior to submission.

  • Funding The study was conducted by staff at the MRC Centre for Reproductive Health, which is supported by grant MR/N022556/1. The Edinburgh Family Planning Trust provided funding to employ Clinical Research Nurses.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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