Premium
Safety and acceptability of medical abortion through telemedicine after 9 weeks of gestation: a population‐based cohort study
Author(s) -
Endler M,
Beets L,
Gemzell Danielsson K,
Gomperts R
Publication year - 2019
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15553
Subject(s) - medicine , abortion , gestation , medical abortion , obstetrics , odds ratio , pregnancy , gestational age , confidence interval , cohort study , population , gynecology , misoprostol , genetics , environmental health , biology
Objective To assess the safety and acceptability of abortion through telemedicine at >9 +0 weeks of gestation. Design Cohort study. Setting Poland. Population Six hundred and fifteen women who requested and underwent a abortion through telemedicine from 1 June to 31 December 2016. Methods Risks of adverse outcomes were calculated as adjusted odds ratios ( aOR s) with 95% confidence intervals (95% CI s) by unconditional logistic regression according to gestational age at abortion: ≤9 or >9 weeks of gestation. Main outcome measures Self‐reported clinical visits for complaints related to the abortion within 0–1 days of the treatment, heavy bleeding, pain or bleeding more than expected, and low satisfaction. Results Among women undergoing a abortion at ≤9 or >9 weeks of gestation, 3.3 versus 11.7% went to hospital with concerns within 0–1 days of the termination ( aOR 3.82, 95% CI 1.90–7.69). Among women undergoing a abortion from 11 +1 to 14 +2 weeks of gestation, the rate was 22.5% ( aOR 9.20, 95% CI 3.58–23.60). Among women undergoing a abortion at ≤9 or >9 weeks of gestation, the rate of heavy bleeding was 6.8 versus 10.1% ( aOR 1.65, 95% CI 0.90–3.04), the rate of low satisfaction was 2.4 versus 1.6% ( aOR 0.69, 95% CI 0.14–3.36), the rate of bleeding more than expected was 45.6 versus 57.8% ( aOR 1.26, 95% CI 0.78–2.02), and the rate of pain more than expected was 35.6 versus 38.8% ( aOR 1.11, 95% CI 0.71–1.71). Conclusions Medical abortion through telemedicine at >9 weeks of gestation is associated with a higher risk of same‐day or day‐after clinical 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. Tweetable abstract A cohort study shows that abortion through telemedicine at >9 weeks of gestation is associated with more hospital visits but not with increased bleeding.