Telemedicine appears safe, effective, acceptable for women seeking medical abortion

Key takeaways:

• Complete abortion rates were high but not significantly different between the telemedicine or in-person groups.
• The risk difference for failed abortion between telemedicine and in-person groups was 3.2%.

Telemedicine consultations for medical abortion appear safe, effective and acceptable to U.K. women seeking to terminate their pregnancy at home, according to results of a small randomized controlled trial published in BMJ Open.

“Telemedicine consultations could add flexibility for women (eg, consultation from home), and benefit services with reduced footfall in clinics and allow for more flexible staff working (including remote working). It is also possible that women may be better prepared for early medical abortion: having a telemedicine consultation in advance of receipt of medications may mean they have had more time to process the information provided about early medical abortion, as well as any information about postabortion contraception options,” John Joseph Reynolds-Wright, MBChB, clinical research fellow at the MRC Centre for Reproductive Health in the Institute for Regeneration and Repair at the University of Edinburgh, U.K., and colleagues wrote. “Doing this prior to attending clinic for ultrasound (which was nearly universal prior to COVID-19) and treatment provision, may give further opportunity to clarify areas of uncertainty for abortion treatment or select a contraceptive method.”

Reynolds-Wright and colleagues began recruiting pregnant women aged 16 years and older in the U.K. who were seeking medical abortion at home in January 2020. Recruitment was stopped early due to COVID-19 and suspended in March 2020. Researchers recruited 125 pregnant women, 10% of the initial goal, and these women were randomly assigned to telemedicine (n = 63; mean age, 28.2 years) or in-person (n = 62; mean age, 27.5 years) consultations.

The primary outcome was medical abortion efficacy defined as complete abortion without the need for surgical intervention. Secondary outcomes included consultation satisfaction, preparedness, unscheduled contact with care, complication rate, time spent in clinical contact and uptake of long-acting contraception.

By the end of the study, two women in the telemedicine and eight women in the in-person groups were lost to follow-up, leaving 115 women with data on medical abortion efficacy. The complete abortion rate was high overall and not statistically significantly different between the telemedicine (90.5%) or in-person (77.4%) groups regarding medical abortion efficacy, and noninferiority was not demonstrated. The risk difference between telemedicine and in-person groups for failed abortion was 3.2%.

Five women in the telemedicine and 10 women in the in-person groups did not complete questionnaires, leaving 110 women with data on secondary outcomes. Researchers also noted that there were no significant differences in most secondary outcomes except for unscheduled contact with care and overall time spent in clinical contact. Unscheduled contact with care was higher in the telemedicine group (19% vs. 5%; P = .01), and the overall mean time spent in clinical contact was lower in the telemedicine group compared with the in-person group (94 vs. 111 minutes; P = .0005).

According to the researchers, due to this study’s small sample size resulting from early cessation, the study was underpowered and findings warrant further investigation in larger studies.

“We theorized that this model of care may give women more time to consider contraceptive options and make a decision to select a more effective method than when confronted with this choice in a face-to-face clinic. However, in this trial as well as in subsequent observational cohort studies, we have conducted at the same center during COVID-19, this has not appeared to be the case,” the researchers wrote. “Further study is needed to better link women to effective postabortion contraception.”