Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
BJOG. 2019 Apr;126(5):609-618. doi: 10.1111/1471-0528.15553. Epub 2018 Dec 27.
To assess the safety and acceptability of abortion through telemedicine at >9 weeks of gestation.
Cohort study.
Poland.
Six hundred and fifteen women who requested and underwent a abortion through telemedicine from 1 June to 31 December 2016.
Risks of adverse outcomes were calculated as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) by unconditional logistic regression according to gestational age at abortion: ≤9 or >9 weeks of gestation.
Self-reported clinical visits for complaints related to the abortion within 0-1 days of the treatment, heavy bleeding, pain or bleeding more than expected, and low satisfaction.
Among women undergoing a abortion at ≤9 or >9 weeks of gestation, 3.3 versus 11.7% went to hospital with concerns within 0-1 days of the termination (aOR 3.82, 95% CI 1.90-7.69). Among women undergoing a abortion from 11 to 14 weeks of gestation, the rate was 22.5% (aOR 9.20, 95% CI 3.58-23.60). Among women undergoing a abortion at ≤9 or >9 weeks of gestation, the rate of heavy bleeding was 6.8 versus 10.1% (aOR 1.65, 95% CI 0.90-3.04), the rate of low satisfaction was 2.4 versus 1.6% (aOR 0.69, 95% CI 0.14-3.36), the rate of bleeding more than expected was 45.6 versus 57.8% (aOR 1.26, 95% CI 0.78-2.02), and the rate of pain more than expected was 35.6 versus 38.8% (aOR 1.11, 95% CI 0.71-1.71).
Medical abortion through telemedicine at >9 weeks of gestation is associated with a higher risk of same-day or day-after clinical visits for concerns related to the procedure, and this risk increases with gestational age. Self-reported rates of heavy bleeding, low satisfaction, or unmet expectations with medical abortion do not increase with gestational age.
A cohort study shows that abortion through telemedicine at >9 weeks of gestation is associated with more hospital visits but not with increased bleeding.
评估在妊娠 9 周以上通过远程医疗进行人工流产的安全性和可接受性。
队列研究。
波兰。
2016 年 6 月 1 日至 12 月 31 日期间，共有 615 名要求并接受远程医疗人工流产的妇女。
根据流产时的妊娠周数（≤9 周或＞9 周），将不良结局的风险计算为调整后的优势比（aOR）及其 95%置信区间（95%CI）。
治疗后 0-1 天内报告的与流产相关的临床就诊、大出血、疼痛或出血量超过预期，以及低满意度。
在妊娠≤9 周或＞9 周行人工流产的妇女中，治疗后 0-1 天内因担心出现并发症而前往医院的比例分别为 3.3%和 11.7%（aOR 3.82，95%CI 1.90-7.69）。在妊娠 11-14 周行人工流产的妇女中，该比例为 22.5%（aOR 9.20，95%CI 3.58-23.60）。在妊娠≤9 周或＞9 周行人工流产的妇女中，大出血的发生率分别为 6.8%和 10.1%（aOR 1.65，95%CI 0.90-3.04），低满意度的发生率分别为 2.4%和 1.6%（aOR 0.69，95%CI 0.14-3.36），出血量超过预期的发生率分别为 45.6%和 57.8%（aOR 1.26，95%CI 0.78-2.02），疼痛超过预期的发生率分别为 35.6%和 38.8%（aOR 1.11，95%CI 0.71-1.71）。
妊娠 9 周以上通过远程医疗进行药物流产与更高的当日或次日因与手术相关的问题而就诊的风险相关，且该风险随妊娠周数增加而增加。自报的大出血、低满意度或对药物流产的期望未得到满足的发生率并未随妊娠周数增加而增加。
一项队列研究表明，妊娠 9 周以上通过远程医疗进行的人工流产与更多的医院就诊相关，但与出血增加无关。
