Abortion via telemedicine as safe as seeing doctor in person

(Reuters Health) - Though 18 states insist that doctors see abortion patients in person, new research shows that medication abortion is just as safe when doctors guide patients in the use of abortion-inducing drugs using remote video technology.

“We can really say definitively now that there is no increased risk of complications among women who obtain medication abortion by telemedicine as opposed to women who have an in-person visit with a physician,” said lead author Dr. Daniel Grossman, an obstetrician-gynecologist and professor at the University of California, San Francisco.

The findings, published in Obstetrics and Gynecology, could have legal ramifications given that the U.S. Supreme Court ruled last year that only health concerns can limit a woman’s right to choose to have an abortion, he said in a phone interview.

The study compared adverse event rates in women who took a pill to induce an abortion during a clinic visit with an in-person doctor, and in women who took the pill while getting instructions from an out-of-office physician over a two-way video connection.

Adverse events in both groups were rare, the study found. In fact, they were even less common among women in the telemedicine group, although the difference was small and might have been due to chance.

Researchers studied more than 19,000 medical abortions at Planned Parenthood of the Heartland clinics in Iowa from 2008 to 2015. About 10,000 of the procedures were performed with doctors in the room administering the medication, and the rest were performed via telemedicine.

Women received a combination of the drugs mifepristone and misoprostol, also known as RU-486, to terminate pregnancies up to 10 weeks of gestation.

Overall during the seven-year study period, the medication abortions led to reports of 49 clinically significant adverse events, affecting fewer than 1 percent of women in each group. There were 16 such events in telemedicine patients (for a rate of 0.18 percent) and 33 among in-person patients (or 0.32 percent).

Women who required hospitalization related to a medical abortion were considered to have experienced an adverse event.

No one died or required surgery after taking the drugs.

“Now we have clear data that there is no health benefit of limiting telemedicine provision of medication abortion, and there are harms of restricting access,” Grossman said.

Women’s chances of obtaining a first-trimester abortion instead of a more risky second-trimester abortion rose by nearly 50 percent in the two years after Planned Parenthood of the Heartland introduced telemedicine into its clinics in 2008, Grossman found in an earlier study.

In 2013, the Iowa Board of Medicine passed a rule prohibiting medication abortion via telemedicine. Planned Parenthood sued the board, and in 2015, the Iowa Supreme Court struck down the restriction.

The court’s unanimous decision found that the regulation violated the state’s constitution and placed an “undue burden” on women seeking abortions because many of them would need to drive hundreds of miles to reach a Planned Parenthood clinic.

Kelly Cleland of Princeton University’s Office of Population Research in New Jersey said she welcomed the new research confirming the safety of medical abortion via telemedicine.

“I am glad to see this study confirming what many of us in the field assume, that medical abortion provided via telemedicine is very safe,” she said in an email.

The findings did not surprise Cleland, who was not involved with the research.

“There’s no reason to think that there would be a safety difference whether medical abortion is provided in-person rather than through telemedicine,” she said. “The difference is who hands the woman the pills.”

Early medication abortions accounted for 31 percent of nonhospital abortions in 2014, according to the Guttmacher Institute.

SOURCE: Obstetrics and Gynecology, online September 7, 2017.