Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern IrelandBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2011 (Published 16 May 2017) Cite this as: BMJ 2017;357:j2011
- Abigail R A Aiken, assistant professor and faculty associate1 2,
- Irena Digol, physician3 4,
- James Trussell, professor emeritus and honorary fellow5 6,
- Rebecca Gomperts, founder and director7
- 1LBJ School of Public Affairs, University of Texas at Austin, TX 78713, USA
- 2Population Research Center, University of Texas at Austin, TX 78712, USA
- 3Women on Web International Foundation, Amsterdam, Netherlands
- 4Centre for Reproductive Health and Medical Genetics, Chisinau, Moldova
- 5Office of Population Research, Princeton University, NJ 08544, USA
- 6Chalmers Centre, University of Edinburgh, Edinburgh EH3 9ES, UK
- 7Women on Web International Foundation, Amsterdam, Netherlands
- Correspondence to: A Aiken
- Accepted 20 April 2017
Objectives To assess self reported outcomes and adverse events after self sourced medical abortion through online telemedicine.
Design Population based study.
Setting Republic of Ireland and Northern Ireland, where abortion is unavailable through the formal healthcare system except in a few restricted circumstances.
Population 1000 women who underwent self sourced medical abortion through Women on Web (WoW), an online telemedicine service, between 1 January 2010 and 31 December 2012.
Main outcome measures Successful medical abortion: the proportion of women who reported ending their pregnancy without surgical intervention. Rates of adverse events: the proportion who reported treatment for adverse events, including receipt of antibiotics and blood transfusion, and deaths reported by family members, friends, or the authorities. Care seeking for symptoms of potential complications: the frequency with which women reported experiencing symptoms of a potentially serious complication and the proportion who reported seeking medical attention as advised.
Results In 2010-12, abortion medications (mifepristone and misoprostol) were sent to 1636 women and follow-up information was obtained for 1158 (71%). Among these, 1023 women confirmed use of the medications, and follow-up information was available for 1000. At the time women requested help from WoW, 781 (78%) were <7 weeks pregnant and 219 (22%) were 7-9 weeks pregnant. Overall, 94.7% (95% confidence interval 93.1% to 96.0%) reported successfully ending their pregnancy without surgical intervention. Seven women (0.7%, 0.3% to 1.5%) reported receiving a blood transfusion, and 26 (2.6%, 1.7% to 3.8%) reported receiving antibiotics (route of administration (IV or oral) could not be determined). No deaths resulting from the intervention were reported by family, friends, the authorities, or the media. Ninety three women (9.3%, 7.6% to 11.3%) reported experiencing any symptom for which they were advised to seek medical advice, and, of these, 87 (95%, 87.8% to 98.2%) sought attention. None of the five women who did not seek medical attention reported experiencing an adverse outcome.
Conclusions Self sourced medical abortion using online telemedicine can be highly effective, and outcomes compare favourably with in clinic protocols. Reported rates of adverse events are low. Women are able to self identify the symptoms of potentially serious complications, and most report seeking medical attention when advised. Results have important implications for women worldwide living in areas where access to abortion is restricted.
Contributors: ARAA conceived the original research question, conducted the statistical analyses and prepared the tables and figures, and wrote the first draft of the manuscript. ARAA, RG, and JT contributed to the study design. RG and ID provided the de-identified data. ARAA and JT did the initial data interpretation. All authors contributed to final data interpretation, revised first and subsequent drafts critically for intellectual content, and approved the final manuscript. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. ARAA is guarantor.
Funding: This study was funded by a grant from the Society of Family Planning (SFPRF10-JI2) and was supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the NIH through grant R24HD04284 to the population research centre at the University of Texas at Austin, and in part by grant P2C HD047879 to the office of population research at Princeton University. The funders played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The authors are completely independent from the funding sources. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the Society of Family Planning or the National Institutes of Health.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare grants from the Society of Family Planning (ARAA) and infrastructure support from the National Institutes of Health (JT and ARAA); RG is founder and director of Women on Web, ID is a prescribing physician for Women on Web, JT serves on the Board of the Women on Web Foundation; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The University of Texas at Austin institutional review board reviewed and approved study protocols and declared the use of the de-identified database for research purposes exempt from full board review. All women consented to the anonymised use of their data at the aggregate level for research purposes.
Transparency: The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained
Data sharing: No additional data available.
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