Telemedicine for medical abortion: a systematic review.

Background: Telemedicine is increasingly being used to access abortion services.
Objective: To assess the success rate, safety, and acceptability for women and providers of medical abortion using telemedicine.
Search Strategy: We searched PubMed, EMBASE, ClinicalTrials.gov, and Web of Science up until 10 November 2017.
Study Criteria: We selected studies where telemedicine was used for comprehensive medical abortion services, i.e. assessment/counselling, treatment, and follow up, reporting on success rate (continuing pregnancy, complete abortion, and surgical evacuation), safety (rate of blood transfusion and hospitalisation) or acceptability (satisfaction, dissatisfaction, and recommendation of the service).
Data Collection and Analysis: Quantitative outcomes were summarised as a range of median rates. Qualitative data were summarised in a narrative synthesis.
Main Results: Rates relevant to success rate, safety, and acceptability outcomes for women ≤10 ⁺⁰ weeks' gestation (GW) ranged from 0 to 1.9% for continuing pregnancy, 93.8 to 96.4% for complete abortion, 0.9 to 19.3% for surgical evacuation, 0 to 0.7% for blood transfusion, 0.07 to 2.8% for hospitalisation, 64 to 100% for satisfaction, 0.2 to 2.3% for dissatisfaction, and 90 to 98% for recommendation of the service. Rates in studies also including women >10 ⁺⁰ GW ranged from 1.3 to 2.3% for continuing pregnancy, 8.5 to 20.9% for surgical evacuation, and 90 to 100% for satisfaction. Qualitative studies on acceptability showed no negative impacts for women or providers.
Conclusion: Based on a synthesis of mainly self-reported data, medical abortion through telemedicine seems to be highly acceptable to women and providers, success rate and safety outcomes are similar to those reported in literature for in-person abortion care, and surgical evacuation rates are higher.
Tweetable Abstract: A systematic review of medical abortion through telemedicine shows outcome rates similar to in-person care.
(© 2019 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.)