@article{Reynolds-Wright_J-2021_118333,
title = {Telemedicine medical abortion at home under 12 weeks’ gestation: a prospective observational cohort study during the COVID-19 pandemic},
author = {Reynolds-Wright, J. and Johnstone, A. and McCabe, K. and Evans, E. and Cameron, S.},
month = {feb},
year = {2021},
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.},
pages = {246-251},
volume = {47},
issue = {4},
journal = {BMJ Sexual & Reproductive Health},
publisher = {BMJ Publishing Group},
url = {http://dx.doi.org/10.1136/bmjsrh-2020-200976},
}
