Evidence map›Paper›PMID 33605016›Full record

ArticleBJOG : an international journal of obstetrics and gynaecology2021

Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study.

Ara Aiken, P A Lohr, J Lord, N Ghosh, J Starling

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BJOG : an international journal of obstetrics and gynaecology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 89 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
89citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

89 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
  2. The use of telemedicine services for medical abortion.The Cochrane database of systematic reviews · 2025
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  8. Quality of Medication Abortion Services From Pharmacies and Drugstores in Ethiopia: A Two-Stage Study.BJOG : an international journal of obstetrics and gynaecology · 2026
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29 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Ara AikenLBJ School of Public Affairs, University of Texas at Austin, Austin, TX, USA.ORCID 0000-0002-1555-3025
P A LohrBritish Pregnancy Advisory Service, Stratford upon Avon, UK.ORCID 0000-0003-1862-5730
J LordMSI Reproductive Choices, London, UK.ORCID 0000-0003-2819-5973
N GhoshNational Unplanned Pregnancy Advisory Service (NUPAS), Birmingham, UK.
J StarlingMathematica Policy Research, Cambridge, MA, USA.ORCID 0000-0003-4765-360X

Funding

Scientific & Technical CoreP2CHD042849 · NICHD · UNIVERSITY OF TEXAS AT AUSTIN · PI MARK D. HAYWARD · 2017 to 2026
$5.2M
NICHD NIH HHS P2C HD042849
6 · The paper itself

Abstract

objectiveTo compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine.

designCohort analysis.

settingThe three main abortion providers. POPULATION OR SAMPLE: Medical abortions at home at ≤69 days' gestation in two cohorts: traditional model (in-person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no-test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally.

methodsData from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences.

main outcome measuresTreatment success, serious adverse events, waiting times, gestation at treatment, acceptability.

resultsMean waiting time from referral to treatment was 4.2 days shorter in the telemedicine-hybrid model and more abortions were provided at ≤6 weeks' gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine-hybrid model, 0.04% were estimated to be over 10 weeks' gestation at the time of the abortion; all were completed safely at home. Within the telemedicine-hybrid model, effectiveness was higher with telemedicine than in-person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine.

conclusionsA telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care. TWEETABLE ABSTRACT: Compelling evidence from 52 142 women shows no-test telemedicine abortion is safe, effective and improves care.

Indexed as

Abortion, InducedCase-Control StudiesCohort StudiesCOVID-19EnglandFemaleHumansPandemicsPregnancySARS-CoV-2TelemedicineUltrasonography, PrenatalAbortionambulatory care facilities [N02.278.035]health planning [N03.349]induced [E04.520.050]mifepristone [D04.210.500.365.415.580]misoprostol [D23.469.700.660.500]pregnancy complications [C13.703]telemedicine [N04.590.374.800]termination of pregnancy

Identifiers

PMID33605016
PMCPMC8360126

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.