Internal medicine

Cohort study

Economic growth

Family medicine

Biology

Obstetrics

Health care

Emergency medicine

Economics

Medical record

Referral

Abortion

Misoprostol

Pregnancy

Medical abortion

Telemedicine

Gestation

Medical emergency

Cohort

Genetics

Medicine

BJOG An International Journal of Obstetrics & Gynaecology

To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine.Cohort analysis.The three main abortion providers.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.Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences.Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability.Mean 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.A 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.Compelling evidence from 52 142 women shows no-test telemedicine abortion is safe, effective and improves care.

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