{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T23:09:04Z","timestamp":1778108944018,"version":"3.51.4"},"reference-count":24,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T00:00:00Z","timestamp":1635379200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"funder":[{"name":"MRC Centre for Reproductive Health","award":["MR\/N022556\/1"],"award-info":[{"award-number":["MR\/N022556\/1"]}]},{"name":"Edinburgh Family Planning Trust"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2021,10,9]]},"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The Scottish government introduced legislation during the COVID-19 outbreak to permit medical abortion at home with telemedicine. All women received an initial telephone consultation. For those choosing medical abortion, we provided self-administered medications to eligible women with pregnancies under 12 weeks\u2019 gestation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To assess adherence to the recommended abortion drug regimen, with particular focus on the number of misoprostol doses used and the interval between mifepristone and misoprostol administration and the induction\u2013expulsion interval. Additionally, to evaluate use of analgesia, antiemetics and antibiotics, and the side effects, pain and bleeding profile of medical abortion at home.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a prospective cohort study of 663\u2009women choosing medical abortion at home via telemedicine at an NHS abortion service in Edinburgh, Scotland between 1 April and 9 July 2020. Interviewer-administered questionnaires were completed at telephone follow-up 4 and 14 days following treatment. Outcome measures were self-reported and included use of mifepristone and misoprostol, induction\u2013expulsion interval (time from misoprostol administration until expulsion of pregnancy), antiemetics, antibiotics, analgesia use, pain scores, rates of side effects, bleeding and preparedness for treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among the respondents, 652\/663\u2009women (98%) answered at least one questionnaire, and 594\/663 (89.6%) used both abortion medications as directed (24\u201372\u2009hours between medications). The mean (SD) induction\u2013expulsion interval was 4.3 (4.3) hours. Antiemetics were used by 611\/663 (92%), 383\/599 (64%) completed the course of prophylactic antibiotics, and 616\/663 (93%) used analgesia, with mean (SD) worst-pain scores of 6.7 (2.2) out of 10. Regarding side effects, 510\/663 (77%) experienced either nausea, vomiting, diarrhoea or headache, 101\/663 (15%) experienced headache and 510\/663 (77%) experienced bleeding that was heavier than a period; 554\/663, (84%) felt prepared for their treatment by teleconsultation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients are able to correctly self-administer abortion medications following a telemedicine consultation. Further research is required to optimise pain management and gastrointestinal side effects during medical abortion.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsrh-2021-201263","type":"journal-article","created":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T13:22:27Z","timestamp":1635427347000},"page":"185-192","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Adherence to treatment and prevalence of side effects when medical abortion is delivered via telemedicine: a prospective observational cohort study during COVID-19"],"prefix":"10.1136","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6597-1666","authenticated-orcid":false,"given":"John Joseph","family":"Reynolds-Wright","sequence":"first","affiliation":[{"name":"MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK"},{"name":"Chalmers Centre, NHS Lothian, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Johnstone","sequence":"additional","affiliation":[{"name":"MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK"},{"name":"Chalmers Centre, NHS Lothian, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"McCabe","sequence":"additional","affiliation":[{"name":"MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK"},{"name":"Chalmers Centre, NHS Lothian, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Evans","sequence":"additional","affiliation":[{"name":"Edinburgh Clinical Research Facility, The University of Edinburgh, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1168-2276","authenticated-orcid":false,"given":"Sharon","family":"Cameron","sequence":"additional","affiliation":[{"name":"MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK"},{"name":"Chalmers Centre, NHS Lothian, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,10,28]]},"reference":[{"key":"2025100723401390000_48.3.185.1","unstructured":"Royal College of obstetricians and gynaecologists . The care of women requesting induced abortion: evidence-based clinical guideline number 7. London, 2011. Available: https:\/\/www.rcog.org.uk\/globalassets\/documents\/guidelines\/abortion-guideline_web_1.pdf [Accessed 4 Jun 2020]."},{"key":"2025100723401390000_48.3.185.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2019-200568"},{"key":"2025100723401390000_48.3.185.3","unstructured":"Chief Medical Officer for Scotland . Abortion \u2013 Covid-19 \u2013 approval for mifepristone to be taken at home and other contingency measures, 2020. Available: https:\/\/www.sehd.scot.nhs.uk\/cmo\/CMO%282020%2909.pdf [Accessed 20 Oct 2021]."},{"key":"2025100723401390000_48.3.185.4","unstructured":"Public Health Scotland . Termination of pregnancy statistics year ending 2019, 2020. Available: https:\/\/beta.isdscotland.org\/find-publications-and-data\/population-health\/sexual-health\/termination-of-pregnancy-statistics\/ [Accessed 20 Oct 2021]."},{"key":"2025100723401390000_48.3.185.5","unstructured":"Royal College of Obstetricians and Gynaecologists . Coronavirus (COVID-19) infection and abortion care: information for healthcare professionals. London, 2020. Available: https:\/\/bsacp.org.uk\/wp-content\/uploads\/2020\/05\/2020-04-09-coronavirus-covid-19-infection-and-abortion-care.pdf [Accessed 4 Jun 2020]."},{"key":"2025100723401390000_48.3.185.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2020-200976"},{"key":"2025100723401390000_48.3.185.7","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1111\/aogs.13944","article-title":"Information on early medical abortion for women using an audiovisual animation vs face-to-face consultation: a consortium randomized and quasi-randomized trial","volume":"99","author":"Reynolds-Wright","year":"2020","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025100723401390000_48.3.185.8","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1111\/1471-0528.16668","article-title":"Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study","volume":"128","author":"Aiken","year":"2021","journal-title":"BJOG"},{"key":"2025100723401390000_48.3.185.9","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.contraception.2021.03.025","article-title":"Provision of medication abortion in Hawai'i during COVID-19: practical experience with multiple care delivery models","volume":"104","author":"Kerestes","year":"2021","journal-title":"Contraception"},{"key":"2025100723401390000_48.3.185.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2021.03.019"},{"key":"2025100723401390000_48.3.185.11","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.contraception.2018.11.002","article-title":"Medical abortion in the late first trimester: a systematic review","volume":"99","author":"Kapp","year":"2019","journal-title":"Contraception"},{"key":"2025100723401390000_48.3.185.12","article-title":"Medical methods for first trimester abortion","author":"Kulier","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2025100723401390000_48.3.185.13","first-page":"173","article-title":"Prostaglandins and antigestagens for the interruption of early pregnancy","volume":"36","author":"Baird","year":"1988","journal-title":"J Reprod Fertil Suppl"},{"key":"2025100723401390000_48.3.185.14","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16813"},{"key":"2025100723401390000_48.3.185.15","unstructured":"Scottish Government - Minister for Public Health . Women\u2019s Health and Sport. Future arrangements for early medical abortion at home consultation analysis, 2021. Available: https:\/\/www.gov.scot\/publications\/future-arrangements-early-medical-abortion-home-consultation-analysis\/ [Accessed 20 Oct 2021]."},{"key":"2025100723401390000_48.3.185.16","doi-asserted-by":"publisher","DOI":"10.3109\/13625187.2014.950730"},{"key":"2025100723401390000_48.3.185.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2011.12.041"},{"key":"2025100723401390000_48.3.185.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2008.01.084"},{"key":"2025100723401390000_48.3.185.19","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31829d5a33"},{"key":"2025100723401390000_48.3.185.20","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1097\/AOG.0000000000002787","article-title":"Prophylactic pregabalin to decrease pain during medication abortion: a randomized controlled trial","volume":"132","author":"Friedlander","year":"2018","journal-title":"Obstet Gynecol"},{"key":"2025100723401390000_48.3.185.21","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.contraception.2011.08.008","article-title":"Clinical outcomes from a prospective study evaluating the role of ambulation during medical termination of pregnancy","volume":"85","author":"Ojha","year":"2012","journal-title":"Contraception"},{"key":"2025100723401390000_48.3.185.22","unstructured":"Reynolds\u2010Wright JJ , Woldetsadik MA , Morroni C . Pain management for medical abortion before 14 weeks\u2019 gestation. Cochrane Database Syst Rev 2020:1465\u2013858.doi:10.1002\/14651858.CD013525"},{"key":"2025100723401390000_48.3.185.23","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1097\/AOG.0000000000003576","article-title":"Opioid analgesia for medical abortion: a randomized controlled trial","volume":"134","author":"Colwill","year":"2019","journal-title":"Obstet Gynecol"},{"key":"2025100723401390000_48.3.185.24","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.contraception.2020.12.004","article-title":"Two prophylactic pain management regimens for medical abortion \u226463 days' gestation with mifepristone and misoprostol: a multicenter, randomized, placebo-controlled trial","volume":"103","author":"Dragoman","year":"2021","journal-title":"Contraception"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2021-201263","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T06:40:55Z","timestamp":1759905655000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2021-201263"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,28]]},"references-count":24,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,7,12]]},"published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1136\/bmjsrh-2021-201263"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2021-201263","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,28]]}}}