Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland

Abstract

Objectives To assess self reported outcomes and adverse events after self sourced medical abortion through online telemedicine. Design Population based study. Setting Republic of Ireland and Northern Ireland, where abortion is unavailable through the formal healthcare system except in a few restricted circumstances. Population 1000 women who underwent self sourced medical abortion through Women on Web (WoW), an online telemedicine service, between 1 January 2010 and 31 December 2012. Main outcome measures Successful medical abortion: the proportion of women who reported ending their pregnancy without surgical intervention. Rates of adverse events: the proportion who reported treatment for adverse events, including receipt of antibiotics and blood transfusion, and deaths reported by family members, friends, or the authorities. Care seeking for symptoms of potential complications: the frequency with which women reported experiencing symptoms of a potentially serious complication and the proportion who reported seeking medical attention as advised. Results In 2010-12, abortion medications (mifepristone and misoprostol) were sent to 1636 women and follow-up information was obtained for 1158 (71%). Among these, 1023 women confirmed use of the medications, and follow-up information was available for 1000. At the time women requested help from WoW, 781 (78%) were <7 weeks pregnant and 219 (22%) were 7-9 weeks pregnant. Overall, 94.7% (95% confidence interval 93.1% to 96.0%) reported successfully ending their pregnancy without surgical intervention. Seven women (0.7%, 0.3% to 1.5%) reported receiving a blood transfusion, and 26 (2.6%, 1.7% to 3.8%) reported receiving antibiotics (route of administration (IV or oral) could not be determined). No deaths resulting from the intervention were reported by family, friends, the authorities, or the media. Ninety three women (9.3%, 7.6% to 11.3%) reported experiencing any symptom for which they were advised to seek medical advice, and, of these, 87 (95%, 87.8% to 98.2%) sought attention. None of the five women who did not seek medical attention reported experiencing an adverse outcome. Conclusions Self sourced medical abortion using online telemedicine can be highly effective, and outcomes compare favourably with in clinic protocols. Reported rates of adverse events are low. Women are able to self identify the symptoms of potentially serious complications, and most report seeking medical attention when advised. Results have important implications for women worldwide living in areas where access to abortion is restricted.

Motivations and Experiences of People Seeking Medication Abortion Online in the United States

“…And second, would they have found their ensuing abortion experience acceptable? Various models of self‐managed medication abortion have been shown to be safe, effective and acceptable to users in a variety of settings, including online telemedicine in Ireland, community‐based distribution at the Thailand‐Burma border, and a service providing preabortion care with instructions about misoprostol use and postabortion follow‐up in Peru . However, the role played by the accurate instructions, medical advice and emotional support that were part of all of these models is likely to be a factor in their positive outcomes, and such information and support may not be offered by pharmacy sites simply selling medications.…”

Effect of a smartphone intervention on self‐managed medication abortion experiences among safe‐abortion hotline clients in Indonesia: A randomized controlled trial

“…For decades, people around the world have relied on WHO‐recommended medications to terminate unwanted pregnancies, increasingly in contexts where formal‐sector abortion care is restricted, expensive, and/or inaccessible . Studies have suggested that when individuals have accurate information about medication abortion protocols and about what to expect, access to quality medications, and access to follow‐up care if needed, they can safely and effectively manage their own abortions …”

Abortion by telemedicine: an equitable option for Irish women

“…3 The women lived in the Republic of Ireland or Northern Ireland, where abortion laws are among the most restrictive in the world. Almost 95% reported successfully ending their pregnancy, 0.7% required a blood transfusion, 2.6% required antibiotics, and overall 9.3% experienced symptoms potentially requiring medical attention.…”

“…There were no deaths. 3 We already know that medical abortion with mifepristone is one of the safest options and that it is highly effective. 5 6 We also know that clinician assessment of patient eligibility through telemedicine is effective.…”

“…15 Aiken and colleagues report the best safety evidence to date for self sourced medical abortion through telemedicine for women living where high quality healthcare is accessible but legal abortion is not. 3 Repeal of legal restrictions would support the safest and most equitable abortion care for women in Irish jurisdictions. Until then, for the first time in history, women of all social classes in a legally restricted yet high resource setting have equitable access to a reasonable alternative: medical abortion guided by physicians through telemedicine.…”