番茄社区

Early medical abortion provided through online telemedicine was highly effective for women in the Republic of Ireland and Northern Ireland, researchers reported.

Among a cohort of 1,000 women, virtually all of them (99.2%, 95% CI 98.4%-99.7%) reported having ended their pregnancies and 94.7% (93.1% to 96.0%) reported a successful medical abortion without surgical intervention, wrote Abigail R.A. Aiken, MD, MPH, PhD, of the University of Texas at Austin, and colleagues in .

"The biggest take away from this is that self-sourced medication abortion conducted entirely outside the formal healthcare setting can be safe and effective. Moreover, women are highly capable of managing their own abortions and seeking medical attention when the need arises," Aiken told 番茄社区.

"When most people think about self-sourced or self-induced abortion, they tend to think about coat hangers or cold steel tables in back alleys. But in 2017, self-sourced abortion involves a network of people helping and supporting each other through a safe and effective process, in the comfort and dignity of their own homes," she continued, noting that this is a huge step forward for public health.

, Wendy Norman, MD, of the University of British Columbia in Vancouver and Bernard M. Dickens, PhD, of the University of Toronto wrote that the study reports "the best safety evidence to date for self-sourced medical abortion through telemedicine for women living where high quality healthcare is accessible but legal abortion is not.

"For the first time in history, women of all social classes in a legally restricted yet high resource setting have equitable access to a reasonable alternative: medical abortion guided by physicians through telemedicine," they stated.

Aiken's group examined data from Women on Web (WoW), a non-profit organization that provides early medical abortion through online telemedicine in countries where access to safe abortion is restricted. Abortion laws in the Irish Republic and Northern Ireland are among the most restrictive in the world, the authors noted.

They sent abortion medications (200 mg mifepristone and 1,200 μg misoprostol) to 1,636 women living in the Republic and Northern Ireland who used the WoW service from Jan. 1, 2010 to Dec. 31, 2012. Among these women, 1,023 confirmed use of the medications and follow-up information was available for 1,000: 78% were <7 weeks pregnant at the time of requesting help from WoW and 22% were 7-9 weeks pregnant.

Common reasons for not using the medications included having had a spontaneous miscarriage in the meantime, accessing abortion through another path way (such as travelling abroad), and deciding to continue the pregnancy.

The researchers found that the reported rate of successful medical abortion was comparable with rates of those carried out within the formal healthcare system. This was true for when mifepristone and misoprostol were administered in clinic and when mifepristone was administered in clinic and misoprostol was taken at home.

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. No deaths resulting from the intervention were reported by family, friends, the authorities, or the media.

Less than 10% of women (7.6% to 11.3%) reported experiencing any symptom for which they were advised to seek medical advice, and of these, 87 women (95%, 87.8% to 98.2%) sought attention.

"We already know that medical abortion with mifepristone is one of the safest options and that it is highly effective. We also know that clinician assessment of patient eligibility through telemedicine is effective," wrote Norman and Dickens. "What this study adds is an important exploration of whether women in jurisdictions with severe restrictions on abortion but good access to high quality healthcare will self assess and manage potential complications."

Study limitations included use of self-reported data on the outcome and complications of abortion, as well as the inability to ascertain whether the treatment for potential adverse events was appropriate or necessary.

The researchers also acknowledged that the results might not be generalizable: "Higher levels of education and medical knowledge, as well as better access to healthcare compared with women in developing settings, might mean that women in the Republic and Northern Ireland are more likely to use the medications correctly and to seek follow-up care."