Kapp Nathalie, Andersen Kathryn, Griffin Risa, Handayani Amalia Puri, Schellekens Marlies, Gomperts Rebecca
Ipas, Chapel Hill, NC, USA.
Women on Web, Toronto, Canada.
Contracept X. 2021 Jan 25;3:100057. doi: 10.1016/j.conx.2021.100057. eCollection 2021.
To evaluate medical abortion effectiveness and safety in women at 13 or more weeks gestation provided care through Women on Web's telemedicine service.
We conducted a retrospective case study of abortions at 13 or more weeks gestation provided by Women on Web between 2016 and 2019. Women received mifepristone and misoprostol or misoprostol alone for abortion. We extracted demographic characteristics and outcome data for cases with pregnancy continuation outcomes.
We identified 144 women who used medical abortion at 13 or more weeks; 131 (91%) provided abortion outcome data. Almost all, 118 (90%) received mifepristone and misoprostol. The population had an average age of 26 ± 5.8 years, 102 (78%) reported a gestational age of 13 to 15 weeks, 114 (87%) had experienced prior pregnancy, and represented all world regions. Overall, 13 (10%) women reported a continuing pregnancy, with 5 (5%) among women 13 to 15 weeks and 8 (28%) among those ≥16 weeks ( = 0.001); 38 (29%) reported adverse events (heavy bleeding, fever), 53 (43%) sought additional care from a health provider, and 18% of all cases received treatment with D&C/aspiration.
Efficacy of self-administered medical abortion decreases as gestational age increases, risking continuation of pregnancy. Provision through telemedicine at 13 to 15 weeks appears safe and effective.
Limited data suggest that medical abortion through telemedicine services may be a safe option through 15 weeks gestation in settings where there is ready access to the formal health system. More research with adequate sample sizes and high rates of follow-up is needed to inform on the safety of telemedicine for pregnancies 13 weeks and greater.
通过“网络上的女性”远程医疗服务，评估孕13周及以上女性药物流产的有效性和安全性。
我们对2016年至2019年期间“网络上的女性”提供的孕13周及以上流产进行了回顾性病例研究。女性接受米非司酮和米索前列醇或仅接受米索前列醇进行流产。我们提取了妊娠持续结局病例的人口统计学特征和结局数据。
我们确定了144名在孕13周及以上使用药物流产的女性；131名（91%）提供了流产结局数据。几乎所有女性，118名（90%）接受了米非司酮和米索前列醇。研究人群平均年龄为26±5.8岁，102名（78%）报告孕周为13至15周，114名（87%）有过妊娠史，来自世界所有地区。总体而言，13名（10%）女性报告妊娠持续，其中13至15周的女性中有5名（5%），≥16周的女性中有8名（28%）（P = 0.001）；38名（29%）报告有不良事件（大出血、发热），53名（43%）寻求医疗服务提供者的额外护理，所有病例中有18%接受了刮宫/吸宫治疗。
随着孕周增加，自行药物流产的有效性降低，有妊娠持续的风险。在孕13至15周通过远程医疗提供药物流产似乎是安全有效的。
有限的数据表明，在能够方便接入正规卫生系统的环境中，通过远程医疗服务进行药物流产在孕15周内可能是一种安全的选择。需要更多有足够样本量和高随访率的研究，以了解远程医疗对孕13周及以上妊娠的安全性。
