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 “We can really say definitively now that there is no increased risk
of complications among women who obtain medication abortion by
telemedicine as opposed to women who have an in-person visit with a
physician,” said lead author Dr. Daniel Grossman, an
obstetrician-gynecologist and professor at the University of
California, San Francisco.
The findings, published in Obstetrics and Gynecology, could have
legal ramifications given that the U.S. Supreme Court ruled last
year that only health concerns can limit a woman’s right to choose
to have an abortion, he said in a phone interview.
The study compared adverse event rates in women who took a pill to
induce an abortion during a clinic visit with an in-person doctor,
and in women who took the pill while getting instructions from an
out-of-office physician over a two-way video connection.
Adverse events in both groups were rare, the study found. In fact,
they were even less common among women in the telemedicine group,
although the difference was small and might have been due to chance.
Researchers studied more than 19,000 medical abortions at Planned
Parenthood of the Heartland clinics in Iowa from 2008 to 2015. About
10,000 of the procedures were performed with doctors in the room
administering the medication, and the rest were performed via
telemedicine.
Women received a combination of the drugs mifepristone and
misoprostol, also known as RU-486, to terminate pregnancies up to 10
weeks of gestation.
Overall during the seven-year study period, the medication abortions
led to reports of 49 clinically significant adverse events,
affecting fewer than 1 percent of women in each group. There were 16
such events in telemedicine patients (for a rate of 0.18 percent)
and 33 among in-person patients (or 0.32 percent).
Women who required hospitalization related to a medical abortion
were considered to have experienced an adverse event.
No one died or required surgery after taking the drugs.
“Now we have clear data that there is no health benefit of limiting
telemedicine provision of medication abortion, and there are harms
of restricting access,” Grossman said.
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Women’s chances of obtaining a first-trimester abortion instead of a
more risky second-trimester abortion rose by nearly 50 percent in
the two years after Planned Parenthood of the Heartland introduced
telemedicine into its clinics in 2008, Grossman found in an earlier
study.
In 2013, the Iowa Board of Medicine passed a rule prohibiting
medication abortion via telemedicine. Planned Parenthood sued the
board, and in 2015, the Iowa Supreme Court struck down the
restriction.
The court’s unanimous decision found that the regulation violated
the state’s constitution and placed an “undue burden” on women
seeking abortions because many of them would need to drive hundreds
of miles to reach a Planned Parenthood clinic.
Kelly Cleland of Princeton University’s Office of Population
Research in New Jersey said she welcomed the new research confirming
the safety of medical abortion via telemedicine.
“I am glad to see this study confirming what many of us in the field
assume, that medical abortion provided via telemedicine is very
safe,” she said in an email.
The findings did not surprise Cleland, who was not involved with the
research.
“There’s no reason to think that there would be a safety difference
whether medical abortion is provided in-person rather than through
telemedicine,” she said. “The difference is who hands the woman the
pills.”
Early medication abortions accounted for 31 percent of nonhospital
abortions in 2014, according to the Guttmacher Institute.
SOURCE: http://bit.ly/2xQkiRU Obstetrics and Gynecology, online
September 7, 2017.
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