Abortion Pill Via Telemedicine Seen Safe, Effective

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Women prescribed the "abortion pill" after a video conference with a doctor appear to fare as well as those who have a face-to-face visit, a new study finds.

The findings, researchers say, suggest that using technology to expand access to the abortion pill can be safe and effective, though it remains controversial.

The study found that of 449 women seen at Iowa Planned Parenthood clinics, those who were given the abortion pill after a "telemedicine" consult had a successful abortion 99 percent of the time.

That compared with 97 percent among women who saw a doctor in person.
And there was no difference in the rate of serious side effects which were seen in just over 1 percent of women in each group, the researchers report in the journal Obstetrics & Gynecology.

"I think our findings indicate that the clinical outcomes with medical abortion provided through telemedicine are the same as when the procedure is provided with a face-to-face visit with a physician," said Dr. Daniel Grossman, an obstetrician/gynecologist at the University of California, San Francisco, and a researcher with Ibis Reproductive Health.

Ibis is an Oakland-based research group that advocates expanding women's access to reproductive healthcare services.

In the U.S., medical abortions, those done using drugs, rather than surgery, can be performed within nine weeks of the first day of a woman's last menstrual period.

Most involve taking the drug mifepristone (Mifeprex), commonly known as the "abortion pill," followed by misoprostol, a hormone that causes the womb to contract.

But because most U.S. women do not live near a clinic that offers medical abortions, telemedicine is considered one way to boost women's access to them.

Telemedicine uses webcams and other electronic technology to connect doctors with each other and with patients at remote locations. It has been used for years to bring specialist healthcare to people who live far from large medical centers.

But its use to expand access to the abortion pill is controversial.

Abortion opponents charge that "webcam abortions" pose a health risk to women because there is no face-to-face meeting with a doctor. And several U.S. states, Arizona, Kansas, Nebraska, North Dakota and Tennessee, have recently banned telemedicine abortions.

Planned Parenthood began using telemedicine to provide medical abortion in Iowa in 2008, when only three of the state's 17 Planned Parenthood clinics had a doctor on site.

The program allows women to go to any Planned Parenthood clinic in the state, see a staff member, have an ultrasound and then consult with a doctor via videoconference. The doctor can then remotely open a container to provide the patient with the abortion pill.

In their study, Grossman and his colleagues found no evidence that telemedicine abortions put women at any increased risk.

Of the 223 women who had one, all but three had a successful abortion. Two of those women had to have a procedure to complete the abortion; one decided to continue with her pregnancy.
Of 226 women who saw a doctor in person, seven ultimately needed a procedure to complete the abortion.

When it came to risks, 1.3 percent of women in each group of a larger collection of medical abortion patients had an "adverse event," which most often meant a failed abortion.

Of women in the telemedicine group, 0.3 percent had excessive bleeding that required a blood transfusion, as did 0.1 percent of women in the face-to-face group—a difference that was likely due to chance.

"The procedure is very effective, with a low risk of complications, and women are generally very satisfied with medical abortion," Grossman told Reuters Health in an email.

His team found that 91 percent of all women in the study said they were "very satisfied" with the procedure, and women in the telemedicine group were more likely to say they'd recommend it to a friend.

At the same time, though, one-quarter of women in the telemedicine group said that in retrospect, they would have preferred seeing a doctor in person.

"Our findings suggest that it's important for women to be well-informed about what telemedicine entails," Grossman said, "so they can decide if that's the way they would like to have the service."
It will be important, Grossman said, for the Iowa clinics to keep tracking complications to see whether telemedicine abortions carry any special risks.

That should be easy to do, he added, because all medical abortion providers have to report adverse events to the Food and Drug Administration and to Danco, the company that makes Mifeprex.

It's estimated that nearly 1.4 million U.S. women have used the abortion pill since its approval a decade ago. It accounts for about one-quarter of all abortions done in the first nine weeks of pregnancy and 15 percent of all abortions.