Telemedicine for medical abortion service provision in Mexico: A safety, feasibility, and acceptability study

Telemedicine Abortion

“…Rates of blood transfusion were very low (< 1%), [4][5][6]9,[13][14][15]36,[42][43][44][45]48 and all but 2 studies 14,46 reported rates of hospital admission below 1%. [4][5][6]9,13,15,36,[43][44][45] No ectopic pregnancies were reported in the 2 studies that evaluated this outcome. 13,36 Reported infection rates were low, at 0.3% and 0.5%.…”

“…Efficacy is high for patients who receive their medications by mail as well as for those who pick them up in a hospital or clinic. Telemedicine abortion is most effective at <70 days gestational age, with rates of complete abortion ranging from 90.1% 42 to 98.7%, 4,6,14,15,[43][44][45][46][47][48] low rates of ongoing pregnancy (0% 42 to 3% 6,14,15,43,45,46 ) and low rates of surgical intervention (0.9% 6 to 6% 4,14,15,42,43,46,47 ). These findings are comparable to the safety of medication abortion provided in clinic, both from prior studies and in a randomized controlled trial comparing telemedicine to in-person medication abortion.…”

“…These findings are comparable to the safety of medication abortion provided in clinic, both from prior studies and in a randomized controlled trial comparing telemedicine to in-person medication abortion. 45,49 In a majority of studies evaluating telemedicine for medication abortion, preabortion tests, including ultrasound, hCG, or pelvic examination, were compulsory, 6,9,[13][14][15][43][44][45][46][47]50,51 while in a few, ultrasound and/or laboratory tests were only required in cases of uncertain gestation or to confirm intrauterine pregnancies among patients who had already undergone clinical assessment. 4,24,36,42,48,52 Aiken et al 24 and Kerestes et al 13 showed comparable efficacy for no-test telemedicine abortion and medication abortion with mandatory preabortion laboratory testing, imaging studies, or physical examination, whereas Anger et al 52 found higher rates of incomplete abortion in the no-test group versus testing group (risk difference 4.0%).…”

“…14,47 Most patients would recommend the telemedicine abortion service to a friend, 6,14,15,47,50,57,58 and between 66% 56 and 97.7% 58 stated that they would choose the service in the future. 14,15,24,36,43,45,47,52,54,56 Patients across multiple studies reported that they were satisfied with their experience, 59 felt comfortable using the telehealth service 60 and had positive experiences with their abortion provider. 59,61,62 Grindlay et al 62 reported that patients felt more comfortable asking questions during a telemedicine visit because of internalized or anticipated abortion stigma that would have been exacerbated by speaking to a provider in person.…”

“…Numerous studies have examined the safety of telemedicine abortion, 5,6,9,13–15,24,36,42–46,48,52,54 including rates of blood transfusion, hospital admission, unplanned clinical encounters, and infection. No deaths have been reported to be attributable to telemedicine abortion.…”