Aiken Abigail R A, Romanova Evdokia P, Morber Julia R, Gomperts Rebecca
LBJ School of Public Affairs, University of Texas at Austin, Austin, TX 78713, USA.
Aid Access, Amsterdam, the Netherland.
Lancet Reg Health Am. 2022 Jun;10. doi: 10.1016/j.lana.2022.100200. Epub 2022 Feb 17.
As access to clinical abortion care becomes increasingly restricted in the United States, the need for self-managed abortions (i.e. abortions taking place outside of the formal healthcare setting) may increase. We examine the safety, effectiveness, and acceptability of self-managed medication abortion provided using online telemedicine.
We retrospectively examined records of the outcomes of abortions provided by the sole online telemedicine service providing self-managed medication abortion in the U.S. We calculated the prevalence of successful medication abortion (the proportion who ended their pregnancy without surgical intervention); the prevalence of serious adverse events (the proportions who received intravenous antibiotics and blood transfusion); and assessed whether any deaths were reported to the service. We also examined the proportions who were satisfied and felt self-management was the right choice.
Between March 20th 2018 and March 20th 2019, abortion medications were mailed to 4,584 people and 3,186 (70%) provided follow-up information. Among these, 2,797 (88%) confirmed use of the medications and provided outcome information, while 389 (12%) confirmed non-use. Overall, 96.4% (95% CI 95.7% to 97.1%) of those who used the medications reported successfully ending their pregnancy without surgical intervention and 1.0% (CI 0.7%-1.5%) reported treatment for any serious adverse event. Among these, 0.6% (CI 0.4% to 1.0%) reported receiving a blood transfusion, and 0.5% (CI 0.3% to 0.9%) reported receiving intravenous antibiotics. No deaths were reported to the service by family, friends, the authorities, or the media. Among 2,268 who provided information about their experience, 98.4% were satisfied and 95.5% felt self-management was the right choice.
Self-managed medication abortion provided using online telemedicine can be highly effective with low rates of serious adverse events. In light of increasingly restricted access to in-clinic abortion in the U.S., it may offer a safe and effective option for those who cannot access clinical care.
The Society of Family Planning and The National Institutes of Health.
在美国，随着临床堕胎护理的获取日益受限，自我管理堕胎（即在正规医疗保健环境之外进行的堕胎）的需求可能会增加。我们研究了通过在线远程医疗提供自我管理药物流产的安全性、有效性和可接受性。
我们回顾性研究了美国唯一提供自我管理药物流产的在线远程医疗服务机构所提供堕胎结果的记录。我们计算了药物流产成功的发生率（即无需手术干预终止妊娠的比例）；严重不良事件的发生率（接受静脉注射抗生素和输血的比例）；并评估是否有任何死亡事件报告给该服务机构。我们还研究了感到满意且认为自我管理是正确选择的比例。
在2018年3月20日至2019年3月20日期间，堕胎药物被邮寄给4584人，其中3186人（70%）提供了后续信息。在这些人中，2797人（88%）确认使用了药物并提供了结果信息，而389人（12%）确认未使用。总体而言，使用药物的人中96.4%（95%置信区间95.7%至97.1%）报告成功终止妊娠且无需手术干预，1.0%（置信区间0.7% - 1.5%）报告接受了任何严重不良事件的治疗。其中，0.6%（置信区间0.4%至1.0%）报告接受了输血，0.5%（置信区间0.3%至0.9%）报告接受了静脉注射抗生素。家人、朋友、当局或媒体均未向该服务机构报告任何死亡事件。在提供其经历信息的2268人中，98.4%感到满意，95.5%认为自我管理是正确选择。
通过在线远程医疗提供的自我管理药物流产可能非常有效，严重不良事件发生率较低。鉴于美国临床堕胎的获取日益受限，对于无法获得临床护理的人来说，它可能提供一种安全有效的选择。
计划生育协会和美国国立卫生研究院。
