Department of Women's and Children's Health, Division of Obstetrics and Gynecology Karolinska Institutet, Amsterdam, The Netherlands.
Women on Waves, Amsterdam, The Netherlands.
Contraception. 2014 Feb;89(2):129-33. doi: 10.1016/j.contraception.2013.11.005. Epub 2013 Nov 12.
To evaluate the need for and outcome of self-administered medical abortion with mifepristone and misoprostol in Brazil, provided through Women on Web, a global telemedicine abortion service.
A retrospective case review of women from Brazil who contacted Women on Web in 2011. Information from the online consultation, follow-up questionnaire and emails were used to analyze data including demographics, gestational age, outcome of the medical abortion and symptoms that lead to surgical interventions.
The Women on Web website had 109779 unique visitors from Brazil, 2104 women contacted the helpdesk by email. Of the 1401 women who completed the online consultation, 602 women continued their request for a medical abortion. Of the 370 women who used the medicines, 307 women gave follow-up information about the outcome of the medical abortion. Of these, 207 (67.4%) women were 9 weeks or less pregnant, 71 (23.1%) were 10, 11 or 12 weeks pregnant, and 29 (9.5%) women were 13 weeks or more pregnant. There was a significant difference in surgical intervention rates after the medical abortion (19.3% at <9 weeks, 15.5% at 11-12 weeks and 44.8% at >13 weeks, p=.06). However, 42.2% of the women who had a surgical intervention had no symptoms of a complication.
There is large need for medical abortion in Brazil. Home use of mifepristone and misoprostol provided through telemedicine is safe and effective. However, after 13 weeks gestation, there is an increased risk of surgical intervention that may be due to the regimen used and local clinical practices in Brazil.
The current study shows that there is an unmet need for medical abortion in Brazil, a country with legal restrictions on access to safe abortion services. Telemedicine can help fulfill the need and self administration of medical abortion is safe and effective even at late first trimester abortion. Prospective trials are needed to establish safety, effectiveness and acceptability of home use of medical abortion beyond 12 weeks of pregnancy.
评估巴西通过全球远程医疗堕胎服务 Women on Web 自行使用米非司酮和米索前列醇进行药物流产的需求和结果。
对 2011 年联系 Women on Web 的巴西妇女进行回顾性病例回顾。使用在线咨询、随访问卷和电子邮件中的信息来分析包括人口统计学、妊娠龄、药物流产结果和导致手术干预的症状在内的数据。
Women on Web 网站有 109779 名来自巴西的独特访客，有 2104 名妇女通过电子邮件联系帮助台。在完成在线咨询的 1401 名妇女中，有 602 名妇女继续要求进行药物流产。在使用药物的 370 名妇女中，有 307 名妇女提供了药物流产结果的随访信息。其中，207 名（67.4%）妇女怀孕 9 周或以下，71 名（23.1%）妇女怀孕 10、11 或 12 周，29 名（9.5%）妇女怀孕 13 周或以上。药物流产后手术干预率有显著差异（<9 周为 19.3%，11-12 周为 15.5%，>13 周为 44.8%，p=.06）。然而，42.2%接受手术干预的妇女没有并发症症状。
巴西对药物流产的需求很大。通过远程医疗自行使用米非司酮和米索前列醇是安全有效的。然而，在 13 周妊娠后，手术干预的风险增加，这可能是由于巴西使用的方案和当地的临床实践。
本研究表明，巴西对安全堕胎服务的获取受到法律限制，存在未满足的药物流产需求。远程医疗可以帮助满足这一需求，即使在妊娠早期流产的后期，自行使用药物流产也是安全有效的。需要进行前瞻性试验，以确定在家使用药物流产至 12 周以上妊娠的安全性、有效性和可接受性。
