Revised telemedicine for medical abortion during COVID-19

  • Edna Astbury-Ward, Medscape.com

  • UK Medical News
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In a surprising double U-turn, the Government reissued emergency guidance for women who are seeking an early (defined as a pregnancy that has not exceeded 9 weeks and 6 days) medical abortion.

Temporary approval has been given for women to be able to take the first abortion pill at home instead of having to travel into a previously approved place such as their GP clinic or abortion provider site just to take the first of two pills (normally taken 1-2 days apart).

Time Limited

The latest Government guidance, which currently only applies to England, expires on the day on which the temporary provisions of the Coronavirus Act 2020 cease, or the end of the period of 2 years beginning with the day on which it is made, whichever is earlier.

Yesterday, Wales issued similar guidance. Welsh Health Minister Vaughan Gething said: "This temporary measure ensures that women can continue to access these key services without being exposed to unnecessary risk during these challenging times."

It is not surprising that women are unsure about what they can and cannot do if they are seeking a medical abortion during the COVID-19 pandemic. The Royal College of Obstetricians & Gynaecologists (RCOG) and the Faculty of Sexual & Reproductive Health have both welcomed the reinstated temporary legislation to the Abortion Act 1967 but urge the Government to introduce similar measures for Scotland, Wales and Northern Ireland to help protect frontline staff. NICE guidance already recommends telemedicine for early abortion based on a raft of high-quality evidence.

In joint clinical guidance issued by FSRH, RCOG, the Royal College of Midwives (RCM) and British Society of Abortion Care Providers (BSACP) covering abortion care during the COVID-19 pandemic, the Guideline offers an evidence-based approach to delivering best practice abortion care using well-established models that are already widely used, but may have until now been limited or restricted in UK practice.

Telemedicine

The new guidance proposes that to ensure safe and effective abortion care during the COVID-19 pandemic, greater use of remote consultations via video or telephone should be used for accessing medical abortion at home where necessary. This is especially important where women and staff may be self-isolating, or where acute hospital facilities are unavailable. The new guidance makes clear that for all remote consultations there must be the same standards as face-to-face consultations to ensure sufficient information and time, including the opportunity to ask any questions and to give informed consent to proceed with the abortion. Consent does not require a written signature, but an entry must be made in the clinical notes that the woman has given informed consent.

They advise that experience from providers who regularly use telemedicine shows that both women and staff value video-links, with solutions that can be delivered from a mobile phone without the need to download additional software being easiest to implement. Providers need to ensure the woman has adequate privacy at the start of the consultation.

Following consent from the patient the abortion medication (if approved) can be either collected (with minimal contact) or posted to the woman’s home together with an abortion information pack which includes:

  • Abortion medication

  • Any additional medication (e.g. analgesia, anti-emetic)

  • Low sensitivity pregnancy test

  • Written advice and information

  • Plan for remote follow-up

Most (72%) abortion care in the UK is delivered by the independent sector providers (ISPs): the British Pregnancy Advisory Service (BPAS), Marie Stopes International UK (MSI) and the National Unplanned Pregnancy Advisory Service (NUPAS). However, currently, thousands of face-to-face appointments for abortion care have been cancelled due to staff shortages, sickness and self-isolation. 

Adapted from Medscape UK.