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Adherence to treatment and prevalence of side effects when medical abortion is delivered via telemedicine: a prospective observational cohort study during COVID-19
  1. John Joseph Reynolds-Wright1,2,
  2. Anne Johnstone1,2,
  3. Karen McCabe1,2,
  4. Emily Evans3,
  5. Sharon Cameron1,2
  1. 1 MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
  2. 2 Chalmers Centre, NHS Lothian, Edinburgh, UK
  3. 3 Edinburgh Clinical Research Facility, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr John Joseph Reynolds-Wright, The University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, Edinburgh, UK; jjrw{at}


Background The Scottish government introduced legislation during the COVID-19 outbreak to permit medical abortion at home with telemedicine. All women received an initial telephone consultation. For those choosing medical abortion, we provided self-administered medications to eligible women with pregnancies under 12 weeks’ gestation.

Aims To assess adherence to the recommended abortion drug regimen, with particular focus on the number of misoprostol doses used and the interval between mifepristone and misoprostol administration and the induction–expulsion interval. Additionally, to evaluate use of analgesia, antiemetics and antibiotics, and the side effects, pain and bleeding profile of medical abortion at home.

Methods We conducted a prospective cohort study of 663 women choosing medical abortion at home via telemedicine at an NHS abortion service in Edinburgh, Scotland between 1 April and 9 July 2020. Interviewer-administered questionnaires were completed at telephone follow-up 4 and 14 days following treatment. Outcome measures were self-reported and included use of mifepristone and misoprostol, induction–expulsion interval (time from misoprostol administration until expulsion of pregnancy), antiemetics, antibiotics, analgesia use, pain scores, rates of side effects, bleeding and preparedness for treatment.

Results Among the respondents, 652/663 women (98%) answered at least one questionnaire, and 594/663 (89.6%) used both abortion medications as directed (24–72 hours between medications). The mean (SD) induction–expulsion interval was 4.3 (4.3) hours. Antiemetics were used by 611/663 (92%), 383/599 (64%) completed the course of prophylactic antibiotics, and 616/663 (93%) used analgesia, with mean (SD) worst-pain scores of 6.7 (2.2) out of 10. Regarding side effects, 510/663 (77%) experienced either nausea, vomiting, diarrhoea or headache, 101/663 (15%) experienced headache and 510/663 (77%) experienced bleeding that was heavier than a period; 554/663, (84%) felt prepared for their treatment by teleconsultation.

Conclusion Patients are able to correctly self-administer abortion medications following a telemedicine consultation. Further research is required to optimise pain management and gastrointestinal side effects during medical abortion.

  • abortion
  • therapeutic
  • COVID-19
  • health services research
  • mifepristone
  • patient safety
  • reproductive health

Data availability statement

No data are available. The original data are not available in a public repository. Please contact the corresponding author for any data requests to be considered.

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Data availability statement

No data are available. The original data are not available in a public repository. Please contact the corresponding author for any data requests to be considered.

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  • Contributors JJR-W and SC 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. JJR-W is the guarantor of this paper.

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.