Conclusion
This large study of 52,145 medical abortions demonstrates that
incorporating no-test telemedicine into the care pathway is not inferior
to the traditional pathway where all patients are seen in person and
have an ultrasound scan. There are advantages - waiting times and
gestation at abortion are reduced and it is highly rated by patients.
There was no evidence of worse outcomes in failure rate, haemorrhage,
need for surgery or in failure to detect ectopic pregnancy. In the
0.04% of cases where the abortion appeared to have been provided at
over 10 weeks’ gestation, these were all completed at home without
additional medical complications. Given the advantages of improving
access to care, especially in vulnerable groups and in resource-poor
healthcare systems or where patients often have to fund their own care,
the evidence is compelling that no-test telemedicine should become
routine in the provision of abortion care.