Clinical outcomes after telemedicine abortion with and without
ultrasound: a multinational cohort study
Abstract
Objective: To evaluate the association between pre- and postabortion
ultrasound and clinical outcomes after telemedicine abortion. Design:
Cohort study Setting: Chile, Northern Ireland, Poland, South Korea.
Population: 5298 women who performed abortion through the telemedicine
service Women on Web (WOW), January 1st 2016 – December 31st 2019.
Methods: We performed a retrospective cohort study on the associations
between use of ultrasound pre-abortion and clinical outcomes using
unconditional multivariate logistic regression. Intervention rates
following routine or clinically indicated postabortion ultrasound were
analysed using descriptive statistics. Main outcome measures:
Self-reported rates of heavy bleeding, clinical visits within 2 days of
the abortion, treatment for incomplete abortion, continuing pregnancy,
and satisfaction. Results: Women with and without a pre-abortion
ultrasound had similar rates of heavy bleeding (10.5% vs10%, AOR 0.98,
95% CI= 0.8-1.19), continuing pregnancy (1% vs 1.3%, AOR 0.68, 95%
CI= 0.39-1.19), and satisfaction (96.8% vs 97%, AOR 0.95, 95% CI=
0.67-1.35). Women with a pre-abortion ultrasound were more likely to
visit a hospital within two days of the abortion (6.6% vs 4.4%, AOR
1.35, 95% CI= 1.04-1.75) and receive treatment for incomplete abortion
(13.7% vs 8.7%, AOR 1.58, 95% CI= 1.32-1.9). Overall rates of
surgical evacuation for incomplete abortion were 9.8% after routine
postabortion ultrasound and 27.6% for clinically indicated ultrasound.
Conclusion: Non-use of pre-abortion ultrasound was not associated with
higher rates of adverse clinical outcomes or lower satisfaction. Routine
postabortion ultrasound may result in unnecessary clinical
interventions. The results come from observational data where a certain
selection bias is possible.