Telemedicine medical abortion at home under 12 weeks’ gestation: a prospective observational cohort study during the COVID-19 pandemic
In response to the COVID-19 pandemic, legislation and guidance were introduced in Scotland permitting medical abortion at home by telemedicine for pregnancies at less than 12 weeks’ gestation. Until recently, medical abortion care in Britain typically involved an in-person clinical consultation and a routine ultrasound scan to assess gestational age. However, new recommendations from the Royal College of Obstetricians and Gynaecologists for the provision of abortion care were introduced that supported telemedicine consultations (telephone or video call) and gestational assessment based on the date of last menstrual period.
Study Methodology
The research was conducted as a prospective cohort study of 663 women choosing medical abortion at home via the NHS Lothian telemedicine abortion service between 1 April and 9 July 2020. Under this model, women had a telephone consultation with a clinician and routine ultrasound was not performed. Medications and a low-sensitivity pregnancy test to confirm success of treatment were collected by or delivered to the woman, with telephone support provided as needed. To evaluate the results, interviewer-administered questionnaires were completed 4 and 14 days following treatment, and regional hospital databases were reviewed to verify abortion outcomes and complications within 6 weeks.
Clinical Outcomes and Safety
The results showed that almost all (642/663, 98.2%) the women were under 10 weeks’ gestation. For 522/663 (78.7%) women, gestation was determined using last menstrual period alone. In terms of efficacy, some 650/663 (98%) women had a complete abortion, 5 (0.8%) an ongoing pregnancy and 4 (0.6%) an incomplete abortion. Safety data indicated that no one was treated inadvertently beyond 12 weeks’ gestation, but one woman was never pregnant. There were two cases of haemorrhage and no severe infections recorded during the study.
| Outcome Measure | Result (n=663) |
|---|---|
| Complete Abortion | 650 (98%) |
| Ongoing Pregnancy | 5 (0.8%) |
| Incomplete Abortion | 4 (0.6%) |
| Care Rated Very or Somewhat Acceptable | 628 (95%) |
Acceptability and Service Implications
The service proved highly popular with patients, as most (628, 95%) women rated their care as very or somewhat acceptable. During the follow-up period, some 123 (18.5%) women sought advice by telephone for a concern related to the abortion and 56 (8.4%) then attended a clinic for review. These findings suggest that telemedicine medical abortion at home in the first trimester without routine ultrasound is effective, with low complication rates and high acceptability. Furthermore, if given the choice, most women would choose a telemedicine consultation again rather than an in-person visit. Consequently, telemedicine service models need flexibility and resources to accommodate those women requiring clinical review post-abortion including ultrasound assessment.