title: Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine.
abstract: OBJECTIVE
  Analysis of factors influencing surgical intervention rate after home medical termination of pregnancy (TOP) by women in countries without access to safe services using the telemedical service 'Women on Web'.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Women with an unwanted pregnancy less than nine weeks pregnant who used the telemedicine service of Women on Web between February 2007 and September 2008 and provided follow-up information.
  
  
  METHODS
  Women who used medical TOP with a known follow up.
  
  
  METHODS
  Information from the online consultation, follow-up form and emails was used to analyze the outcome of the TOP.
  
  
  METHODS
  Ongoing pregnancy, reason for surgical intervention, perceived complications and satisfaction.
  
  
  RESULTS
  Of the 2 323 women who did the medical TOP and had no ongoing pregnancy, 289 (12.4%) received a surgical intervention. High rates were found in Eastern Europe (14.8%), Latin America (14.4%) and Asia/Oceania (11.0%) and low rates in Western Europe (5.8%), the Middle East (4.7%) and Africa (6.1%; p=0.000). More interventions occurred with longer gestational age (p=0.000). Women without a surgical intervention more frequently reported satisfaction with the treatment (p=0.000).
  
  
  CONCLUSIONS
  The large regional differences in the rates of reported surgical interventions after medical TOP provided by telemedicine cannot be explained by demographic factors or differences in gestational length. It is likely that these differences reflect different clinical practice and local guidelines on (incomplete) abortion rather than complications that genuinely needed surgical intervention. Surgical interventions significantly influenced womens' views on the acceptability of the TOP.
authors.affiliation: Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. gomperts@womenonwaves.org
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gomperts
authors.forename: Sabine A M
authors.initials: SA
authors.lastname: Petow
authors.forename: Kinga
authors.initials: K
authors.lastname: Jelinska
authors.forename: Louis
authors.initials: L
authors.lastname: Steen
authors.forename: Kristina
authors.initials: K
authors.lastname: Gemzell-Danielsson
authors.forename: Gunilla
authors.initials: G
authors.lastname: Kleiverda
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage; D000028:Abortion, Induced / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015735:Mifepristone / Q000008:administration & dosage; D016595:Misoprostol / Q000008:administration & dosage; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011247:Pregnancy; D011446:Prospective Studies; D012646:Self Administration; D011795:Surveys and Questionnaires; D017216:Telemedicine; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone