Objective
To evaluate the need for and outcome of self-administered medical abortion with mifepristone and misoprostol in Brazil, provided through Women on Web, a global telemedicine abortion service.
Study Design
A retrospective case review of women from Brazil who contacted Women on Web in 2011. Information from the online consultation, follow-up questionnaire and emails were used to analyze data including demographics, gestational age, outcome of the medical abortion and symptoms that lead to surgical interventions.
Results
The Women on Web website had 109779 unique visitors from Brazil, 2104 women contacted the helpdesk by email. Of the 1401 women who completed the online consultation, 602 women continued their request for a medical abortion. Of the 370 women who used the medicines, 307 women gave follow up information about the outcome of the medical abortion. Of these, 207 (67.4%) women were 9 weeks or less pregnant, 71 (23.1%) were 10, 11 or 12 weeks pregnant, and 29 (9.5%) women were 13 weeks or more pregnant. There was a significant difference in surgical intervention rates after the medical abortion (19.3% at <9 data-blogger-escaped-11="" data-blogger-escaped-15.5="" data-blogger-escaped-44.8="" data-blogger-escaped-and="" data-blogger-escaped-at="" data-blogger-escaped-weeks="">13 weeks, p=0.06). However 42.2% of the women who had a surgical intervention had no symptoms of a complication.
Conclusion
There is large need for medical abortion in Brazil. Home use of mifepristone and misoprostol provided through telemedicine is safe and effective. However after 13 weeks gestation there is an increased risk of surgical intervention that may be due to the regimen used and local clinical practices in Brazil.
Implications
The current study shows that there is an unmet need for medical abortion in Brazil, a country with legal restrictions on access to safe abortion services. Telemedicine can help fulfill the need and self administration of medical abortion is safe and effective even at late first trimester abortion. Prospective trials are needed to establish safety, effectiveness and acceptability of home use of medical abortion beyond 12 weeks of pregnancy.
Large numbers of women needed surgical abortion... and this is a success?
Giving self-administered medical abortion to women who are 13 weeks pregnant (many of whom needed surgical intervention afterwards) strikes me as medical malpractice. Normally, such abortions are done in a hospital setting where progress can be monitored.
