Impact of self-administration of misoprostol for early medical abortion: a prospective observational cohort study

Abstract

IntroductionIn October 2017, Scotland legalised the home use of misoprostol for the purpose of early medical abortion (EMA). Women up to 9+6 weeks’ gestation can now self-administer the drug at home, 24–48 hours after receiving mifepristone in the clinic.ObjectiveTo evaluate the impact of this change on the uptake and success rate of EMA, and on the provision of effective contraception on discharge.MethodsA prospective observational study was conducted to compare the outcomes of two cohorts of women in the 6 months before and 6 months after the introduction of home administration of misoprostol. The main outcome measures were uptake of EMA, success of EMA and provision of long-acting reversible contraception (LARC) to women undergoing EMA.ResultsThere was a statistically significant increase in the uptake of EMA from 698/1075 (64.9%) women in the first study period to 823/1146 (71.8%) in the second study period. There was no statistically significant difference in the success rate of EMA: 99.3% and 98.9% in clinic and home misoprostol cohorts, respectively. There was also no statistically significant difference in the proportion of women provided with LARC: 37.7% and 33.7% in clinic and home misoprostol cohorts, respectively.ConclusionsSelf-administration of misoprostol at home increased uptake of EMA, with no effect on the high success rate that was previously seen with clinic administration of misoprostol. In addition, the reduced number of visits associated with home use of misoprostol has not affected the provision of effective contraception to women.

Telemedicine medical abortion at home under 12 weeks’ gestation: a prospective observational cohort study during the COVID-19 pandemic

“…In our study, rates of telephone contact to the service for a concern related to the abortion were similar to our previous studies. 14 15 However, we did observe a higher proportion of women requiring a post-abortion clinic attendance (8.4%) compared with our former service model with routine pre-abortion ultrasound and clinic-administered mifepristone with misoprostol at home (2.7%). 14 The majority of the post-abortion clinic visits were to exclude continuing pregnancy following a positive or invalid LSPT.…”

“…These findings are similar to previous cohort studies from this service of women who took misoprostol at home having had routine ultrasound and mifepristone in clinic. 14 15 17 Women reported high levels of preparedness to use the medications in their own homes. Indeed, acceptability of care was high, and the majority of women expressed a preference for choosing this model of care again in the future.…”

“…For women over 12 weeks’ gestation or choosing surgical abortion, the existing arrangements for direct admission to the local hospital for this procedure were made. 14 An overview of the telemedicine care pathway can be seen in online supplemental figure 1 .…”

Women’s experiences of self-administration of misoprostol at home as part of early medical abortion: a qualitative evaluation

“…The rich data generated has enabled further exploration of women's experiences, and areas as yet unexplored in the literature. All women were recruited from one NHS Lothian clinic where 72% of women have EMAH-SaM and where, at the time of fieldwork, this had been an option for over a year [6]. The findings may not be reflective of women's experiences where the service is newer.…”

“…Between 2017 -2019, legislation was introduced in the UK that approved the home as a place for self-administration of misoprostol for early medical abortion (≤69 days gestation). While research has shown that early medical abortion at home is as safe as in a clinical setting [6], UK women's experiences in the context of this change have not yet been investigated. This qualitative research explores the experiences of women choosing EMAH-SaM, in one region of Scotland, UK.…”