'COVID changed UK laws to allow more early abortions to occur at home'
[Self-reported??]
- Gestational cutoff for early medication abortion at home varies across countries in Great Britain.
- Both at-home and in-hospital early medication abortion groups had 97% complete abortion rates.
- Authors call for changed laws to expand access to at-home early medication abortion across the U.K. to up to 12 weeks' gestation.
Early medication abortion outcomes were similar when performed at home as when in a hospital for women between 10 and 12 weeks' gestation, a retrospective review of U.K. data found.
Among 371 women who had an early medication abortion, complete abortion rates didn't differ significantly between at-home versus hospital medication abortion (97% [251/258], 95% CI 94-99% and 97% [110/113], 95% CI 92-99%), reported researchers led by Jacqueline Quinn, MBChB, of the University of Edinburgh Medical Research Council Centre for Reproductive Health and Chalmers Sexual Health Centre in Edinburgh, Scotland.
Neither did significant differences emerge between the home and hospital groups in incomplete abortion rates (1.6% vs 2.6%), nor in ongoing pregnancy rates (1.2% vs 0%), they wrote in BMJ Sexual and Reproductive Health.
Only four total cases of serious complications occurred -- one hemorrhage requiring transfusion and three cases of infection receiving intravenous antibiotics, all within the at-home group.
"This study demonstrates that early medical abortion at home should be extended to allow women across the U.K. to access this up to 12 weeks if they wish to," Quinn told MedPage Today. "Therefore, the law and regulations in other parts of the U.K. need to be changed to allow women access to this procedure between 10 and 12 weeks."
Since the COVID-19 pandemic, Britain has allowed early medication abortion at home, though England and Wales allow this option up to 9 weeks 6 days' gestation and Scotland permits it through 11 weeks 6 days' gestation. The WHO endorses both medication abortion at home up to 12 weeks' gestation as well as telemedicine and hybrid models of care for medication abortion.
Rates of follow-up visits were low but more likely in the at-home medication abortion group (7% vs 2%, P=0.03) and with telephone advice (11% vs 4%, P=0.04). The at-home group was also more likely to make unscheduled contact with the hospital or abortion clinic (23% vs 9%, P≤0.01).
Ashley Brant, DO, MPH, an ob/gyn and complex family planning subspecialist at the Cleveland Clinic who was not involved in the research, told MedPage Today that these findings suggest "that providing instructions on how and when to seek additional care or medical advice is an important part of pre-abortion counseling."
She also noted that this study "supports the safety and efficacy of medication abortion via telemedicine at 10 to 11 weeks" and that "regulations, policies, and protocols that restrict access to medication abortion or require in-person evaluation do not improve the safety of abortion and are not grounded in medical evidence."
Researchers reviewed 5 years (April 2020 through March 2025) of routinely collected audit data from a health center in Edinburgh. Specifically, they compared outcomes of at home versus hospital cases of early medication abortion for patients between 10 weeks 0 days' and 11 weeks 6 days' gestation. In total, 258 had an at-home abortion and 113 had one in the hospital.
Both groups followed the same early medication abortion regimen: 200 mg of mifepristone, taken orally, followed 24 to 28 hours later with 800 µg of misoprostol (Cytotec), taken sublingually or vaginally. Patients were also provided with three additional 400-µg doses of misoprostol to take at 4 hour intervals, if necessary, until the abortion was complete. They were also given dihydrocodeine for analgesia and cyclizine as an antiemetic. A self-performed low-sensitivity urinary pregnancy test taken 2 weeks after the medication provided confirmation of a successful early medication abortion.
Complete abortion rate, defined by Medical Abortion Reporting of Efficacy guidelines as complete expulsion without requiring surgical intervention, was the primary outcome. Secondary outcomes included incomplete abortion, ongoing pregnancy, unscheduled contact with a hospital or abortion services due to an abortion-related concern within 6 weeks, and serious complications, like hemorrhage requiring transfusion or an infection receiving intravenous antibiotics.
Authors noted some limitations, including the small number of cases of abortion presenting this early. More patients in the at-home group didn't have a pre-abortion ultrasound to confirm gestational age, which means gestation could have been earlier or more advanced than predicted, though past research has determined that last menstrual period is accurate enough in most cases.
Quinn said the group plans to interview patients who have had at-home early medication abortion about their experience.
Disclosures
Quinn is a trainee editor of BMJ Sexual and Reproductive Health.
Co-authors reported being an an editor-in-chief and associate editor of BMJ Sexual and Reproductive Health; receiving research funding from Perrigo (HRA Pharma) and Nordic Pharma (Exelgyn) and grants from Gedeon Richter; being a European scientific advisory board member for Exelgyn on early medical abortion; and being principal investigator for a progestogen-only injectable study.
Brant had no disclosures.
