An interesting study by Chong and others published in the International Reproductive Health Journal of Contraception on March 26, 2021 looked at this subject. 

They performed the study at 10 sites providing a termination service in 13 states and Washington DC.  Interested patients obtained any needed pre-abortion tests locally and had a video conference with a study clinician.  Sites then sent study packages containing Mifepristone and Misoprostol by mail and had remote follow-up consultations within one month by telephone or by an online survey if the participant could not be reached to evaluate the effectiveness and completeness of the termination. 

They mailed 1390 packages between May 2016 and September 2020.  Of the 83% of terminations for which they obtained outcome information 95% were completed without a procedure, that was 1103 out of 1157.  

Participants made 70 unplanned visits to emergency rooms or urgent care centres for reasons related to the termination, about 6% and 10 serious adverse events occurred including five transfusions.  

Enrolment into the study increased substantially with the onset of COVID-19 and although a screening ultrasound was required, sites determined that 52%, 346 out of 669, of terminations that occurred during COVID, it was determined that the participants did not need to get the test to protect their health.  

Use of urine pregnancy test to confirm the abortion completeness increased from 6-7% 144 out of 214 in the six months before the pandemic to 19% 602 out of 669 in six months during the pandemic.  Participants reported satisfaction with the service in 99% that is 1013 out of 1022. 

The study concluded that direct to patient telemedicine was safe, effective and acceptable in providing a termination service and supported the claim that there was no medical reason for Mifepristone to be dispensed in clinics as required by the FDA.  They also concluded that in some cases participants did not need to visit any facility to obtain the service, which was critical for protecting patient safety during the COVID-19 pandemic.

Dr Paul Ettlinger
The London General Practice

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