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Safety of Medical Abortion Provided Through Telemedicine Compared With In Person

Grossman, Daniel, MD; Grindlay, Kate, MSPH

doi: 10.1097/AOG.0000000000002212
Contents: Original Research

OBJECTIVE: To compare the proportion of medical abortions with a clinically significant adverse event among telemedicine and in-person patients at a clinic system in Iowa during the first 7 years of the service.

METHODS: We conducted a retrospective cohort study. We analyzed data on clinically significant adverse events (hospital admission, surgery, blood transfusion, emergency department treatment, and death) for all medical abortions performed by telemedicine or in person at a clinic system in Iowa between July 1, 2008, and June 30, 2015. Data on adverse events came from required reporting forms submitted to the mifepristone distributor. We calculated the prevalence of adverse events and 95% CIs comparing telemedicine with in-person patients. The analysis was designed as a noninferiority study. Assuming the prevalence of adverse events to be 0.3%, telemedicine provision was considered to be inferior to in-person provision if the prevalence were 0.6% or higher. The required sample size was 6,984 in each group (one-sided α=0.025, power 90%). To explore whether patients with adverse events presented to emergency departments and were not reported, we conducted a survey of the 119 emergency departments in Iowa, asking whether they had treated a woman with an adverse event in the prior year.

RESULTS: During the study period, 8,765 telemedicine and 10,405 in-person medical abortions were performed. Forty-nine clinically significant adverse events were reported (no deaths or surgery; 0.18% of telemedicine patients with any adverse event [95% CI 0.11–0.29%] and 0.32% of in-person patients [95% CI 0.23–0.45%]). The difference in adverse event prevalence was 0.13% (95% CI −0.01% to 0.28%, P=.07). Forty-two emergency departments responded to the survey (35% response rate); none reported treating a woman with an adverse event after medical abortion.

CONCLUSION: Adverse events are rare with medical abortion, and telemedicine provision is noninferior to in-person provision with regard to clinically significant adverse events.

Telemedicine provision of medical abortion is not associated with a clinically significant increased risk of adverse events compared with in-person abortion care.

Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California; and Ibis Reproductive Health, Cambridge, California.

Corresponding author: Daniel Grossman, MD, ANSIRH, 1330 Broadway, Suite 1100, Oakland, CA 94612; email:

Funded by grants from the Grove Foundation and the Susan Thompson Buffett Foundation.

Financial Disclosure In 2016, Dr. Grossman served as a consultant to the Planned Parenthood Federation of America and provided input on the implementation of services providing medical abortion using telemedicine. The other author did not report any potential conflicts of interest.

Presented at the annual meeting of the National Abortion Federation, April 22–25, 2017, Montreal, Canada.

The authors thank Penny Dickey, Sharon Lebenkoff, Donna Struletz, and Sabrina Werby for their contributions to data collection.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.