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Database - Alliance francophone pour l'accouchement respecté (AFAR)

Description of this bibliographical database (AFAR website)
Currently 3069 records
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Created on : 25 May 2021
Modified on : 25 May 2021

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Bibliographical entry (without author) :

Telemedicine medical abortion at home under 12 weeks’ gestation: a prospective observational cohort study during the COVID-19 pandemic. BMJ Sexual and Reproductive Health.

Author(s) :

John Joseph Reynolds-Wright, Anne Johnstone, Karen McCabe, Emily Evans, Sharon Cameron

Year of publication :

2021

URL(s) :

https://srh.bmj.com/content/early/2021/02/04/bmjsr…
https://doi.org/10.1136/bmjsrh-2020-200976

Résumé (français)  :

Contexte
En réponse à la pandémie de COVID-19, une législation et des directives ont été introduites en Écosse permettant l’avortement médicamenteux à domicile par télémédecine pour les grossesses à moins de 12 semaines de gestation. Les femmes ont eu une consultation téléphonique avec un clinicien. Une échographie de routine n’a pas été réalisée. Les médicaments et un test de grossesse à faible sensibilité pour confirmer le succès du traitement ont été collectés ou livrés à la femme, avec une assistance téléphonique fournie si nécessaire.

Méthodes
Une étude prospective de cohorte de 663 femmes ayant choisi l’avortement médicamenteux à domicile via le service d’avortement par télémédecine du NHS Lothian entre le 1er avril et le 9 juillet 2020. Les questionnaires administrés par les enquêteurs ont été complétés 4 et 14 jours après le traitement. Les bases de données des hôpitaux régionaux ont été examinées pour vérifier les résultats et les complications de l’avortement dans les 6 semaines. Les mesures des résultats comprenaient l’efficacité, les complications et l’acceptabilité.

Résultats
Presque toutes (642/663, 98,2%) les femmes avaient moins de 10 semaines de gestation. Pour 522 femmes sur 663 (78,7%), la gestation a été déterminée en utilisant uniquement la dernière période menstruelle. Quelques 650 femmes sur 663 (98%) ont eu un avortement complet, 5 (0,8%) une grossesse en cours et 4 (0,6%) un avortement incomplet. Personne n’a été traité par inadvertance au-delà de 12 semaines de gestation, mais une femme n’a jamais été enceinte. Une femme qui a subi une échographie avant l’avortement a ensuite été traitée comme une cicatrice extra-utérine par césarienne. Il y a eu deux cas d’hémorragie et aucune infection grave. Quelque 123 femmes (18,5%) ont demandé conseil par téléphone pour un problème lié à l’avortement et 56 (8,4%) se sont ensuite rendues dans une clinique pour examen. La plupart des femmes (628, 95%) ont jugé leurs soins très ou plutôt acceptables.

Conclusions
Ce modèle d’avortement par télémédecine sans échographie de routine est sûr et a une efficacité élevée et une acceptabilité élevée chez les femmes.

Abstract (English)  :

Background
In response to the COVID-19 pandemic, legislation and guidance were introduced in Scotland permitting medical abortion at home by telemedicine for pregnancies at less than 12 weeks’ gestation. Women had a telephone consultation with a clinician. Routine ultrasound was not performed. Medications and a low-sensitivity pregnancy test to confirm success of treatment were collected by or delivered to the woman, with telephone support provided as needed.

Methods
A prospective cohort study of 663 women choosing medical abortion at home via the NHS Lothian telemedicine abortion service between 1 April and 9 July 2020. Interviewer-administered questionnaires were completed 4 and 14 days following treatment. Regional hospital databases were reviewed to verify abortion outcomes and complications within 6 weeks. Outcome measures included efficacy, complications and acceptability.

Results
Almost all (642/663, 98.2%) the women were under 10 weeks’ gestation. For 522/663 (78.7%) women, gestation was determined using last menstrual period alone. Some 650/663 (98%) women had a complete abortion, 5 (0.8%) an ongoing pregnancy and 4 (0.6%) an incomplete abortion. No one was treated inadvertently beyond 12 weeks’ gestation, but one woman was never pregnant. One woman who had a pre-abortion ultrasound was later managed as a caesarean scar ectopic. There were two cases of haemorrhage and no severe infections. Some 123 (18.5%) women sought advice by telephone for a concern related to the abortion and 56 (8.4%) then attended a clinic for review. Most (628, 95%) women rated their care as very or somewhat acceptable.

Conclusions
This model of telemedicine abortion without routine ultrasound is safe, and has high efficacy and high acceptability among women.

Sumário (português)  :

Fundo
Em resposta à pandemia COVID-19, legislação e orientação foram introduzidas na Escócia permitindo o aborto médico em casa por telemedicina para gestações com menos de 12 semanas de gestação. As mulheres tiveram uma consulta por telefone com um clínico. A ultrassonografia de rotina não foi realizada. Os medicamentos e um teste de gravidez de baixa sensibilidade para confirmar o sucesso do tratamento foram coletados ou entregues à mulher, com suporte telefônico fornecido quando necessário.

Métodos
Um estudo de coorte prospectivo de 663 mulheres que escolheram o aborto médico em casa por meio do serviço de telemedicina de aborto do NHS Lothian entre 1º de abril e 9 de julho de 2020. Questionários administrados por entrevistadores foram preenchidos 4 e 14 dias após o tratamento. Bancos de dados de hospitais regionais foram revisados ​​para verificar os resultados do aborto e complicações dentro de 6 semanas. As medidas de desfecho incluíram eficácia, complicações e aceitabilidade.

Resultados
Quase todas (642/663, 98,2%) as mulheres tinham menos de 10 semanas de gestação. Para 522/663 (78,7%) mulheres, a gestação foi determinada usando apenas a última menstruação. Cerca de 650/663 (98%) mulheres tiveram um aborto completo, 5 (0,8%) uma gravidez em curso e 4 (0,6%) um aborto incompleto. Ninguém foi tratado inadvertidamente após 12 semanas de gestação, mas uma mulher nunca ficou grávida. Uma mulher que fez uma ultrassonografia pré-aborto foi posteriormente tratada como uma cicatriz ectópica de cesariana. Ocorreram dois casos de hemorragia e nenhuma infecção grave. Cerca de 123 (18,5%) mulheres procuraram aconselhamento por telefone para uma preocupação relacionada ao aborto e 56 (8,4%) então compareceram a uma clínica para revisão. A maioria (628, 95%) das mulheres classificou seus cuidados como muito ou um pouco aceitáveis.

Conclusões
Este modelo de aborto por telemedicina sem ultrassom de rotina é seguro e tem alta eficácia e alta aceitabilidade entre as mulheres.

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Author of this record :

Marion Corbe — 25 May 2021

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