Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON.
Temerty Faculty of Medicine, University of Toronto, Toronto, ON.
J Obstet Gynaecol Can. 2024 Jun;46(6):102429. doi: 10.1016/j.jogc.2024.102429. Epub 2024 Mar 7.
To evaluate the safety and efficacy of first-trimester "No Touch" medication abortion programs at 2 clinics in Toronto, Ontario during their early implementation in response to the COVID-19 pandemic.
This retrospective study included all patients who underwent virtual consultation for mifepristone-misoprostol medication abortion between April 2020-August 2022 at 2 reproductive health clinics. In response to the pandemic, "No Touch" abortion protocols have been developed that align with the Canadian Protocol for the Provision of Medical Abortion via Telemedicine. Records were reviewed for demographic information, clinical course, investigations required, confirmation of complete abortion and adverse events. The primary outcome was complete medication abortion, defined as expulsion of the pregnancy without requiring uterine aspiration.
A total of 277 patients had abortions initiated in the "No Touch" or "Low Touch" care pathways and had sufficient follow-up to determine outcomes. Of these patients, 92.8% (95% CI 89.7%-95.8%) had a complete medication abortion (n = 257) and 76.1% (n = 159) remained "No Touch" throughout their care. Investigations were performed for 102 participants before or after their abortion, classifying them as "Low Touch". Nineteen patients (6.9%) underwent uterine aspiration. The rate of adverse events was low, with 1 case of a missed ectopic pregnancy and 1 patient requiring hospitalization for endometritis.
"No Touch" provision of mifepristone-misoprostol medication abortion care was safe and effective with outcomes comparable to previous studies. These results provide evidence for the efficacy and safety of a "No Touch" approach in the Canadian context, which has the potential to reduce barriers to accessing abortion care.
评估安大略省多伦多的 2 家诊所应对 COVID-19 大流行期间实施的早期第一孕期“无接触”药物流产计划的安全性和有效性。
本回顾性研究纳入了 2020 年 4 月至 2022 年 8 月期间在 2 家生殖健康诊所接受米非司酮-米索前列醇药物流产虚拟咨询的所有患者。为应对大流行，制定了“无接触”流产方案，这些方案符合加拿大通过远程医疗提供药物流产的方案。对记录进行了回顾，以获取人口统计学信息、临床经过、所需检查、完全流产的确认和不良事件。主要结局为完全药物流产，定义为妊娠物排出而无需子宫抽吸。
共有 277 名患者在“无接触”或“低接触”护理途径下开始流产，并进行了足够的随访以确定结局。这些患者中，92.8%（95%置信区间 89.7%-95.8%）有完全药物流产（n=257），76.1%（n=159）在整个护理过程中保持“无接触”。102 名患者在流产前或后进行了检查，将其归类为“低接触”。19 名患者（6.9%）接受了子宫抽吸。不良事件发生率较低，1 例漏诊宫外孕，1 例患者因子宫内膜炎住院。
米非司酮-米索前列醇药物流产护理的“无接触”提供是安全有效的，结局与既往研究相当。这些结果为加拿大“无接触”方法的有效性和安全性提供了证据，这有可能减少获得堕胎护理的障碍。
