title: Provision of medical abortion using telemedicine in Brazil.
abstract: OBJECTIVE
  To evaluate the need for and outcome of self-administered medical abortion with mifepristone and misoprostol in Brazil, provided through Women on Web, a global telemedicine abortion service.
  
  
  METHODS
  A retrospective case review of women from Brazil who contacted Women on Web in 2011. Information from the online consultation, follow-up questionnaire and emails were used to analyze data including demographics, gestational age, outcome of the medical abortion and symptoms that lead to surgical interventions.
  
  
  RESULTS
  The Women on Web website had 109779 unique visitors from Brazil, 2104 women contacted the helpdesk by email. Of the 1401 women who completed the online consultation, 602 women continued their request for a medical abortion. Of the 370 women who used the medicines, 307 women gave follow-up information about the outcome of the medical abortion. Of these, 207 (67.4%) women were 9 weeks or less pregnant, 71 (23.1%) were 10, 11 or 12 weeks pregnant, and 29 (9.5%) women were 13 weeks or more pregnant. There was a significant difference in surgical intervention rates after the medical abortion (19.3% at <9 weeks, 15.5% at 11-12 weeks and 44.8% at >13 weeks, p=.06). However, 42.2% of the women who had a surgical intervention had no symptoms of a complication.
  
  
  CONCLUSIONS
  There is large need for medical abortion in Brazil. Home use of mifepristone and misoprostol provided through telemedicine is safe and effective. However, after 13 weeks gestation, there is an increased risk of surgical intervention that may be due to the regimen used and local clinical practices in Brazil.
  
  
  CONCLUSIONS
  The current study shows that there is an unmet need for medical abortion in Brazil, a country with legal restrictions on access to safe abortion services. Telemedicine can help fulfill the need and self administration of medical abortion is safe and effective even at late first trimester abortion. Prospective trials are needed to establish safety, effectiveness and acceptability of home use of medical abortion beyond 12 weeks of pregnancy.
authors: Department of Women's and Children's Health, Division of Obstetrics and Gynecology Karolinska Institutet, Amsterdam, The Netherlands. Electronic address: gomperts@womenonwaves.org.
authors: Rebecca
authors: R
authors: Gomperts
authors: Women on Waves, Amsterdam, The Netherlands. Electronic address: info@womenonwaves.org.
authors: Kirsten
authors: K
authors: van der Vleuten
authors: Women's Wallet, Amsterdam, The Netherlands. Electronic address: kmanders@xs4all.nl.
authors: Kinga
authors: K
authors: Jelinska
authors: Women's Wallet, Amsterdam, The Netherlands. Electronic address: cecilia.womenonweb@gmail.com.
authors: Cecilia Veiera
authors: CV
authors: da Costa
authors: Department of Women's and Children's Health, Division of Obstetrics and Gynaecology Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. Electronic address: Kristina.Gemzell@ki.se.
authors: Kristina
authors: K
authors: Gemzell-Danielsson
authors: Department of Obstetrics and Gynaecology, Flevoziekenhuis Almere, Almere, The Netherlands. Electronic address: kleiverd@xs4all.nl.
authors: Gunilla
authors: G
authors: Kleiverda
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D001938:Brazil; D005260:Female; D006801:Humans; D020407:Internet; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D017216:Telemedicine; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brazil; E-health; Home-use; Medical abortion; Mifepristone; Self-administration; Sublingual misoprostol; Telemedicine; Women on Web