Telemedicine for medical abortion: asystematic review

by M Endler, A Lavelanet, A Cleeve, B Ganatra, RGomperts, K Gemzell‐Danielsson

BJOG: AnInternational Journal of Obstetrics & Gynaecology March2019;126(9)

Background: Telemedicine is increasingly being usedto access abortion services.

Objective: To assess the success rate, safety, andacceptability for women and providers of medical abortion using telemedicine.

Search strategy: We searched PubMed, EMBASE,ClinicalTrials.gov, and Web of Science up until 10 November 2017.

Study criteria: We selected studies wheretelemedicine was used for comprehensive medical abortion services, i.e.assessment/counselling, treatment, and follow up, reporting on success rate(continuing pregnancy, complete abortion, and surgical evacuation), safety(rate of blood transfusion and hospitalisation) or acceptability (satisfaction,dissatisfaction, and recommendation of the service).

Data collection and analysis: Quantitative outcomeswere summarised as a range of median rates. Qualitative data were summarised ina narrative synthesis.

Main results: Rates relevant to success rate, safety,and acceptability outcomes for women ≤10weeks’ gestation (GW) ranged from0 to 1.9% for continuing pregnancy, 93.8 to 96.4% for complete abortion, 0.9 to19.3% for surgical evacuation, 0 to 0.7% for blood transfusion, 0.07 to 2.8%for hospitalisation, 64 to 100% for satisfaction, 0.2 to 2.3% fordissatisfaction, and 90 to 98% for recommendation of the service. Rates in studiesalso including women >10GW ranged from 1.3 to 2.3% for continuingpregnancy, 8.5 to 20.9% for surgical evacuation, and 90 to 100% forsatisfaction. Qualitative studies on acceptability showed no negativeimpacts for women or providers.

Conclusion: Based on a synthesis of mainly self‐reporteddata, medical abortion through telemedicine seems to be highly acceptable towomen and providers, success rate and safety outcomes are similar to thosereported in literature for in‐person abortion care, and surgicalevacuation rates are higher.

Tweetable summary by the authors:

A systematic review ofmedical abortion through telemedicine shows outcome rates similar to in‐person care. #SelfManagedAbortion

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Women may appreciate reading thisarticle by a UK abortion provider that says much the same things in a readablestyle:

Self-managed abortions should be universally available, bySam Rowlands, Secretary of the British Society of Abortion Care Providers, TheConversation, 24 March 2020

Importantly, thisarticle tells us that two often routine procedures can safely be omitted withearly abortions for the majority of women: ultrasound scans and blood tests.Italso reports that all mail services between countries have been disrupted by a neartotal lack of international flights. Creative ways of communicating with local pharmaciesor prescribers will therefore be needed.

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Here’s an articleabout how pharmacy workers can provide correct information about using abortionpills after simple training:

Pharmacy workers in Nepal can provide the correct informationabout using mifepristone and misoprostol to women seeking medication to induceabortion

by Anand Tamang,MaheshPuri,Kalyan Lama,Prabhakar Shrestha

ReproductiveHealth Matters Feb 2015;22(44)

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ContraceptionJournal: Special Issue, 2018

You can also find a range of research and discussion articleshere on training pharmacy workers to provide abortion pills, the experience ofclandestine home use, efforts to have the pills approved, a discussion of whetherpills will replace surgical methods, the efficacy of abortion pills at 6 weeks,and much more from Chile, Argentina, Madagascar, Benin and Burkina Faso, Nepal,Bangladesh, Kyrgyzstan, South Africa and the Burma-Thai border.