Medical abortion at 13 or more weeks gestation provided through telemedicine: A retrospective review of services

Abstract

Objectives To evaluate medical abortion effectiveness and safety in women at 13 or more weeks gestation provided care through Women on Web's telemedicine service. Study Design We conducted a retrospective case study of abortions at 13 or more weeks gestation provided by Women on Web between 2016 and 2019. Women received mifepristone and misoprostol or misoprostol alone for abortion. We extracted demographic characteristics and outcome data for cases with pregnancy continuation outcomes. Results We identified 144 women who used medical abortion at 13 or more weeks; 131 (91%) provided abortion outcome data. Almost all, 118 (90%) received mifepristone and misoprostol. The population had an average age of 26 ± 5.8 years, 102 (78%) reported a gestational age of 13 to 15 weeks, 114 (87%) had experienced prior pregnancy, and represented all world regions. Overall, 13 (10%) women reported a continuing pregnancy, with 5 (5%) among women 13 to 15 weeks and 8 (28%) among those ≥16 weeks ( p = 0.001); 38 (29%) reported adverse events (heavy bleeding, fever), 53 (43%) sought additional care from a health provider, and 18% of all cases received treatment with D&C/aspiration. Conclusions Efficacy of self-administered medical abortion decreases as gestational age increases, risking continuation of pregnancy. Provision through telemedicine at 13 to 15 weeks appears safe and effective. Implications Limited data suggest that medical abortion through telemedicine services may be a safe option through 15 weeks gestation in settings where there is ready access to the formal health system. More research with adequate sample sizes and high rates of follow-up is needed to inform on the safety of telemedicine for pregnancies 13 weeks and greater.

Effectiveness of Self-Managed Medication Abortion Between 9 and 16 Weeks of Gestation

“…medically manage abortion between 9 and 16 weeks of gestation. These findings are consistent with the effectiveness reported in retrospective analyses of accompaniment group case records for self-managed medication abortion at these gestations [11][12][13] and underscore the need for access to health care as an important component of the self-managed medication abortion experience. Qualitative studies have highlighted important considerations for self-management at later gestations, 22 namely that the experience can be more physically intense and that the pregnancy tissue is larger and thus carries a higher risk of being discovered, particularly salient in settings where abortion is criminalized.…”

“…The limited number of studies suggest that the practice can be safe and effective; however, limitations such as reliance on retrospective record reviews and loss to follow-up have limited the generalizability of these prior results. 4,[11][12][13] To be responsive to WHO calls for additional research on self-managed medication abortion outcomes at later gestations, we conducted an analysis of data from a prospective, observational cohort study (the SAFE [Studying Accompaniment Feasibility and Effectiveness] study) to estimate the effectiveness of self-managed medication abortion at 9 or more weeks of pregnancy and to describe the population who self-managed at these gestations, the medication abortion protocols used, physical outcomes, and health care-seeking experiences.…”

“…Additional research is needed to evaluate the safety and effectiveness of self-managed medication abortion beyond 16 weeks of gestation. Prior retrospective research on experiences of people who have selfmanaged medication abortion at 17 or more weeks of gestation and those who support them to do so 11,13,22 indicates that the physical and emotional support needs at these gestations differ from those of individuals who self-manage earlier in pregnancy, and these individuals may require more pain management and other physical support for passing the pregnancy, disposing of pregnancy tissue, and managing delayed placental expulsion.…”

Abortion in Countries with Restrictive Abortion Laws—Possible Directions and Solutions from the Perspective of Poland

“…All the respondents were satisfied with such a possibility of performing a pregnancy termination [56]. Similar medical abortion effectiveness and safety were achieved in women at 13 or more weeks gestation through Women on Web telemedicine service [57,58]. The self-administration of abortion-inducing drugs and initial advice are also practiced in countries with limited access to health care, such as Tanzania.…”

Quality of information offered to women by drug sellers providing medical abortion in Nigeria: Evidence from providers and their clients

“…Medication abortion has been identified as partly responsible for the decline in severe abortion-related morbidity and mortality across the globe ( 9 , 10 ). The safety and efficacy of MA when correctly administered, as well as its crucial role in mitigating the consequences of unsafe abortions, have been well documented ( 11 – 13 ). However, the use-effectiveness depends to a large extent on the levels of knowledge and understanding of PPMVs/Pharmacies, compliance to recommended new guidelines by WHO and in-country health care administrators, and the level of information provided to women at the point of purchase.…”