Effectiveness, Safety and Acceptability of No-Test Medical Abortion Provided via Telemedicine

Abstract

Background: In response to COVID-19, the National Health Service (NHS) in Great Britain changed its service model for medical abortion up to 10 weeks’ gestation from in-person to one that included no-test telemedicine. We compared the effectiveness, safety and acceptability of medical abortion before and after the service model change. 

Methods: Data were analysed from the three main abortion providers in England and Wales. We defined two cohorts, each including all medical abortions performed over a two month period before and after the service model change: “traditional”, where care was in-person and included an ultrasound scan, and “telemedicine-hybrid” where medical abortions were provided either by no-test telemedicine or in-person if indicated. 

Findings: We analysed outcomes for 52,142 medical abortions; 22,158 in the traditional cohort and 29,984 in the telemedicine-hybrid cohort of which 61% were no-test telemedicine. The cohorts accounted for 85% of all medical abortions reported in England and Wales. Mean waiting times were 4.2 days shorter in the telemedicine-hybrid cohort; 40% were provided at ≤6 weeks’ gestation compared to 25% in the traditional cohort (p<0.001). There was no difference in success rates in either group (98.2% vs. 98.8%, p=1.0), nor in the prevalence of serious adverse events (0.04% vs. 0.02%, p=0.557). The incidence of ectopic pregnancy was equivalent in both cohorts (0.2%, p=0.796). In 0.04% of cases the abortion appeared to have been provided at over 10 weeks’ gestation; these abortions were all completed at home without additional medical complications. In the telemedicine-hybrid group, the effectiveness for abortions conducted using telemedicine (n=18,435) was higher than for those conducted in-person (n=11,549), 99.2% vs. 98.1%, p<0.001. Acceptability was high (96% satisfied) and 80% reported a future preference for telemedicine. 

Interpretation: Medical abortion provided through no-test telemedicine without routine ultrasound is effective, safe, and acceptable and improves access to care.

Funding Statement: None.

Declaration of Interests: Abigail Aiken - Member of the Council of the British Society of Abortion Care Providers (BSACP).

Nabanita Ghosh - Nothing to disclose.

Patricia A. Lohr - Co-author / committee member of national guidelines cited in this paper from RCOG & NICE; member RCOG abortion taskforce; council member of British Society of Abortion Care Providers (BSACP); Medical Director of BPAS.

Jonathan Lord - Co-author / committee member of national guidelines cited in this paper from RCOG & NICE; co-chair of RCOG abortion taskforce and British Society of Abortion Care Providers (BSACP); primary employment includes work as an abortion care provider as a consultant gynaecologist and medical director.

Jennifer Starling - Nothing to disclose.

Ethics Approval Statement: The study was reviewed by the Institutional Review Board (IRB) at the University of Texas at Austin and a determination was made that the research did not meet the criteria for human subjects research as defined in the Common Rule (45 CFR 46) or FDA Regulations (21 CFR 56). Each provider ensured compliance with their own internal ethics and governance systems. The principles of the STROBE statement, and the MARE supplement, were followed.

Keywords: Abortion, Induced, Telemedicine, Ambulatory Care Facilities, Health Planning, Pregnancy Complications, Mifepristone, Misoprostol