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.