Telemedicine for the provision of medication abortion to pregnant people at up to twelve weeks of pregnancy: a systematic literature review and meta-analysis

Abstract

Background: Telemedicine represents an important strategy to facilitate access to medication abortion (MAB) procedures, reduces distance barriers and expands coverage to underserved communities. The aim is evaluating the self-managed MAB (provided through telemedicine as the sole intervention or in comparison to in-person care) in pregnant people at up to 12 weeks of pregnancy.

Methods: A literature search was conducted using electronic databases: MEDLINE, Embase, Cochrane (Central Register of Controlled Trials and Database of Systematic Reviews), LILACS, SciELO, and Google Scholar. The search was based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework, and was not restricted to any years of publication, and studies could be published in English or Spanish. Study screening and selection, risk of bias assessment, and data extraction were performed by peer reviewers. Risk of bias was evaluated with RoB 2.0 and ROBIS-I. A narrative and descriptive synthesis of the results was conducted. Meta-analyses with random-effects models were performed using Review Manager version 5.4 to calculate pooled risk differences, along with their individual 95% confidence intervals. The rate of evidence certainty was based on GRADE recommendations.

Results: 21 articles published between 2011 and 2022 met the inclusion criteria. Among them, 20 were observational studies, and 1 was a randomized clinical trial. Regarding the risk of bias, 5 studies had a serious risk, 15 had a moderate risk, and 1 had an undetermined risk. In terms of the type of intervention, 7 compared telemedicine to standard care. The meta-analysis of effectiveness revealed no statistically significant differences between the two modalities of care (RD = 0.01; 95%CI 0.00, 0.02). Our meta-analyses show that there were no significant differences in the occurrence of adverse events or in patient satisfaction when comparing the two methods of healthcare delivery.

Conclusion: Telemedicine is an effective and viable alternative for MAB, similar to standard care. The occurrence of complications was low in both forms of healthcare delivery. Telemedicine services are an opportunity to expand access to safe abortion services.

Keywords: Acceptability; Adverse effects; Effectiveness; First trimester; Medication abortion; Meta-analysis; Satisfaction; Standard care; Systematic review; Telemedicine.

Fig. 1

PRISMA diagram: flow of search, screening, and selection of studies

Fig. 2

Bias risk assessment of the included studies

Fig. 3

Effectiveness of medication abortion via telemedicine compared to standard care by gestational week subgroups. A. Pregnant people up to 9 weeks pregnant, B. Pregnant people up to 10 weeks pregnant, C Pregnant people up to 12 weeks pregnant

Fig. 4

Effectiveness of medication abortion via telemedicine compared to standard care by method of pregnancy confirmation. A Self-report, B Serology test, C Ultrasound, D Combined: serology test, urine test or ultrasound, E Combined: serology test or clinical concept

Fig. 5

Surgical intervention after medication abortion via telemedicine compared to standard care

Fig. 6

Hospitalization after medication abortion via telemedicine compared to standard care

Fig. 7

Service satisfaction with medication abortion via telemedicine compared to standard care

Fig. 8

Waiting time for delivery of medication abortion via telemedicine compared to standard care