Provision of medical abortion using telemedicine in Brazil

Gomperts, Rebecca; Vleuten, Kirsten van der; Jelinska, Kinga; Costa, Cecilia Veiera da; Gemzell‐Danielsson, Kristina; Kleiverda, Gunilla

doi:10.1016/j.contraception.2013.11.005

Cited by 64 publications

(70 citation statements)

References 50 publications

(59 reference statements)

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“…Two existing studies have examined data from telemedicine initiatives: one across various settings 6 and the other in Brazil. 13 These studies showed encouraging results with respect to efficacy but were limited by small sample sizes and relatively high losses to follow-up. Moreover, no study has examined whether women are able to safely manage their own abortions by identifying the symptoms of serious complications and presenting for medical advice when appropriate.…”

Section: What This Study Addsmentioning

confidence: 99%

Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland

Aiken

Digol

Trussell

et al. 2017

BMJ

Self Cite

117

125

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Objectives To assess self reported outcomes and adverse events after self sourced medical abortion through online telemedicine. Design Population based study. Setting Republic of Ireland and Northern Ireland, where abortion is unavailable through the formal healthcare system except in a few restricted circumstances. Population 1000 women who underwent self sourced medical abortion through Women on Web (WoW), an online telemedicine service, between 1 January 2010 and 31 December 2012. Main outcome measures Successful medical abortion: the proportion of women who reported ending their pregnancy without surgical intervention. Rates of adverse events: the proportion who reported treatment for adverse events, including receipt of antibiotics and blood transfusion, and deaths reported by family members, friends, or the authorities. Care seeking for symptoms of potential complications: the frequency with which women reported experiencing symptoms of a potentially serious complication and the proportion who reported seeking medical attention as advised. Results In 2010-12, abortion medications (mifepristone and misoprostol) were sent to 1636 women and follow-up information was obtained for 1158 (71%). Among these, 1023 women confirmed use of the medications, and follow-up information was available for 1000. At the time women requested help from WoW, 781 (78%) were <7 weeks pregnant and 219 (22%) were 7-9 weeks pregnant. Overall, 94.7% (95% confidence interval 93.1% to 96.0%) reported successfully ending their pregnancy without surgical intervention. Seven women (0.7%, 0.3% to 1.5%) reported receiving a blood transfusion, and 26 (2.6%, 1.7% to 3.8%) reported receiving antibiotics (route of administration (IV or oral) could not be determined). No deaths resulting from the intervention were reported by family, friends, the authorities, or the media. Ninety three women (9.3%, 7.6% to 11.3%) reported experiencing any symptom for which they were advised to seek medical advice, and, of these, 87 (95%, 87.8% to 98.2%) sought attention. None of the five women who did not seek medical attention reported experiencing an adverse outcome. Conclusions Self sourced medical abortion using online telemedicine can be highly effective, and outcomes compare favourably with in clinic protocols. Reported rates of adverse events are low. Women are able to self identify the symptoms of potentially serious complications, and most report seeking medical attention when advised. Results have important implications for women worldwide living in areas where access to abortion is restricted.

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Section: What This Study Addsmentioning

confidence: 99%

Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland

Aiken

Digol

Trussell

et al. 2017

BMJ

Self Cite

117

125

View full text Add to dashboard Cite

show abstract

“…In reports describing these services, most women obtained an ultrasound for gestational age dating but approximately one‐third who were followed up after receiving treatment had pregnancies which were of 10 weeks of gestation or greater by ultrasound 7, 8…”

Section: Resultsmentioning

confidence: 99%

“…Ideally, these services include trained providers. Reports from Women on Web indicate that women may overestimate complications or require more guidance on what to expect from the termination process given that 12–20% subsequently received a surgical intervention,7, 8, 33 although this may also reflect provider overtreatment or local treatment standards. In contrast, women receiving medical termination from Bangladesh pharmacies reported low rates of seeking medical care.…”

Section: Discussionmentioning

confidence: 99%

A research agenda for moving early medical pregnancy termination over the counter

Kapp¹,

Grossman

Jackson

et al. 2017

BJOG

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Given the overall safety profile and increasing availability of medical pregnancy termination drugs, we asked: would the mifepristone–misoprostol regimen for medical termination at ≤10 weeks of gestation meet US Food and Drug Administration regulatory criteria for over‐the‐counter (OTC) approval, and if not, what are the present research gaps? We conducted a literature review of consumer behaviours necessary for a successful OTC application for medical termination at ≤10 weeks of gestation and identified crucial research gaps. If we were to embark on a development programme for OTC or more generally, self‐use of medical termination, the critical elements missing are the label comprehension, self‐selection and actual use studies.Tweetable abstractConsidering medical pregnancy termination through the over‐the‐counter regulatory lens clarifies critical evidence gaps.

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“…This study assessed self‐reported outcomes and adverse events among women who accessed self‐sourced medical abortion through online telemedicine, which is an option for women where safe, legal abortion care is not available. While self‐sourced online abortion services have been available since 2006 and used by tens of thousands of women around the world, only 2 studies have examined outcomes of telemedicine services, and these were limited by small sample sizes, high losses to follow‐up, and difficulties screening for complications . In the Republic of Ireland, abortion is permitted only to save a woman's life, and in Northern Ireland, only to save women's permanent physical and mental health.…”

Section: Safety and Effectiveness Of Self‐sourced Medical Abortion VImentioning

confidence: 99%

Updates From the Literature, November/December 2017

Bond¹

2017

J Midwife Womens Health

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Provision of medical abortion using telemedicine in Brazil

Cited by 64 publications

References 50 publications

Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland

Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland

A research agenda for moving early medical pregnancy termination over the counter

Updates From the Literature, November/December 2017

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