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Original research article| Volume 89, ISSUE 2, P129-133, February 2014

Provision of medical abortion using telemedicine in Brazil

      Abstract

      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 weeks, 15.5% at 11–12 weeks and 44.8% at >13 weeks, p=.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.

      Keywords

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      References

      1. Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008, 3rd ed. World Health Organization, Geneva2011 (accessed November 19 th, 2012)
      2. Menezes, G, Aquino, EML. Pesquisa sobre o aborto no Brasil: avanços e desafi os para o campo da saúde coletiva [Research on abortion in Brazil: gaps and challenges for the public health field]. Cad. Saúde Pública, 2009;25(2):193–204. (http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2009001400002 accessed on November 19 th, 2012).

        • Guedes A.C.
        Abortion in Brazil: legislation, reality and options.
        Reprod Health Matters. 2000; 8: 66-76
        • Singh S.
        • Monteiro M.
        • Levin J.
        Trends in hospitalization for abortion-related complications in Brazil, 1992–2009: Why the decline in numbers and severity?.
        Int J Gynaecol Obstet. 2012 Sep; 118: S99-S106
        • Miller S.
        • et al.
        Misoprostol and declining abortion related morbidity in Santo Domingo, Dominican Republic: a temporal association.
        Br J Obstet Gynaecol. 2005; 112: 1291-1296
        • Briozzo L.
        • et al.
        A risk reduction strategy to prevent maternal deaths associated with unsafe abortion.
        Int J Gynecol Obstet. 2006; 95: 221-226
      3. Letter to UN Human Rights Council, Geneva Switzerland, São Paulo, November 28, 2011. Re: Brazil — 13th Universal Periodic Review session: misoprostol and violation of the right to health and the right to information on sexual and reproductive heath. Periodic universal review, cycle 2, June 2012, Brazil prepared by The Commission for Citizenship and Reproduction (CCR, Comissão de Cidadania e Reprodução). http://www.ohchr.org/EN/HRBodies/UPR/Pages/BRSession13.aspx accessed November 9th.

        • Gomperts R.
        • et al.
        Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services.
        BJOG. 2008; 115: 1171-1178
        • Gomperts R.
        • et al.
        Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine.
        Acta Obstet Gynecol Scand. 2012; 91: 226-231
        • Royal College of Obstetricians and Gynaecologists
        The care of women requesting induced abortion. Evidence-based guideline no. 7. RCOG Press, London2004
      4. Safe abortion: technical and policy guidance for health systems, Second edition, WHO.
        (accessed November 19 th, 2012)
        • Winikoff B.
        • et al.
        Extending outpatient medical abortion services through 70 days of gestational age.
        Obstet Gynecol. 2012 Nov; 120: 1070-1076
        • Wildschut H.
        • et al.
        Medical methods for mid-trimester termination of pregnancy.
        Cochrane Database Syst Rev. 2011 Jan 19; 1 (CD005216)
        • Ashok P.W.
        • Templeton A.
        • Wagaarachchi P.T.
        • Flett G.M.
        Factors affecting the outcome of early medical abortion: a review of 4132 consecutive cases.
        BJOG. 2002 Nov; 109: 1281-1289
        • Rose S.B.
        • Shand C.
        • Simmins A.
        Mifepristone- and misoprostol-induced mid-trimester termination of pregnancy: a review of 272 cases.
        Aust N Z J Obstet Gynaecol. 2006 Dec; 46: 479-485
        • Mentula M.
        • Heikinheimo O.
        Risk factors of surgical evacuation following second-trimester medical termination of pregnancy.
        Contraception. 2012 Aug; 86: 141-146
        • Raghavan S.
        • et al.
        Acceptability and feasibility of the use of 400 μg of sublingual misoprostol for medical abortion up to 63 days since last menstrual period: evidence from Uzbekistan.
        Eur J Contracept Reprod Health Care. 2013; 18: 104-111
        • Raghavan S.
        • et al.
        Efficacy and acceptability of early mifepristone-misoprostol medical abortion in Ukraine: results of two clinical trials.
        Eur J Contracept Reprod Health. 2013; 18: 112-119