Safety and acceptability of medical abortion by telemedicine above nine gestational weeks: a population-based cohort study

Margit Endler, Leona Beets, Kristina Gemzell, Rebecca Gomperts
BJOG: An International Journal of Obstetrics and Gynaecology 2018 November 19

OBJECTIVE: To assess the safety and acceptability of abortion through telemedicine > 9 (9+0) gestational weeks (gw).

DESIGN: Cohort study.

SETTING: Poland.

POPULATION: 615 women who requested and performed abortion through telemedicine June 1st- December 31st 2016.

METHODS: Risks of adverse outcomes were calculated as adjusted odds ratios (OR) with 95% confidence intervals (CI) by unconditional logistic regression according to gestational age at abortion ≤ or > 9 gw.

MAIN OUTCOME MEASURES: Self-reported hospital visits for concerns related to the abortion within 0-1 days of the abortion, heavy bleeding, pain and bleeding more than expected and low satisfaction.

RESULTS: Among women ≤ 9gw and >9gw, 3.3% vs 11.7% went to hospital for concerns within 0-1 days of the abortion (AOR 3.82, 95% CI 1.90-7.69). Among women 11w+1d-14w+2d the rate was 22.5% (AOR 9.20, 95% CI 3.58-23.60). Among women ≤ 9gwand > 9 gw, the rate of heavy bleeding was 6.8% vs 10.1% (AOR 1.65, 95% CI 0.90-3.04), the rate of low satisfaction was 2.4% vs 1.6% (AOR 0.69, 95% CI 0.14-3.36), the rate of bleeding more than expected was 45.6% vs 57.8% (AOR 1.26, 95% CI 0.78-2.02), and the rate of pain more than expected was 35.6% vs 38.8% (AOR 1.11, 95% CI 0.71-1.71).

CONCLUSIONS: Medical abortion through telemedicine >9 gw is associated with a higher risk of same-day or day-after hospital visits for concerns related to the procedure and this risk increases with gestational age. Self-reported rates of heavy bleeding, low satisfaction or unmet expectations with medical abortion do not increase with gestational age. This article is protected by copyright. All rights reserved.

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