title: [Medical abortion provided by telemedicine to women in Latin America: complications and their treatment].
abstract: OBJECTIVE
  To analyze reported complications and their treatment after a medical abortion with mifepristone and misoprostol provided by a telemedicine service to women living in Latin America.
  
  
  METHODS
  Observational study based on the registry of consultations in a telemedicine service. A total of 872 women who used the service in 2010 and 2011 participated in the study. The dependent variables were overall complications, hemorrhage, incomplete abortion, overall treatments, surgical evacuation, and antibiotics. Independent variables were age, area of residence, socioeconomic deprivation, previous children, pregnancies and abortions, and week of pregnancy. We fitted Poisson regression models with robust variance to estimate incidence ratios and 95% confidence intervals (95%CI).
  
  
  RESULTS
  Complications were reported by 14.6% of the participants: 6.2% reported hemorrhage and 6.8% incomplete abortion. Nearly one-fifth (19.0%) received postabortion treatment: 10.9% had a surgical evacuation and 9.3% took antibiotics. Socioeconomic deprivation increased the risk of complications by 64% (95%CI: 15%-132%), and, among these, the risk of incomplete abortion by 82% (95%CI: 8%-206%) and the risk of surgical intervention by 62% (95%CI: 7%-144%). Previous pregnancies increased the risk of complications and, specifically, the risk of hemorrhage by 2.29 times (95%CI: 1.33-3.95%). Women with a pregnancy of 12 or more weeks had a 2.45 times higher risk of receiving medical treatment and a 2.94 times higher risk of taking antibiotics compared with women with pregnancies of 7 or less weeks.
  
  
  CONCLUSIONS
  Medical abortion provided by telemedicine seems to be a safe and effective alternative in contexts where it is legally restricted.
authors.affiliation: Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España.
authors.forename: Sara
authors.initials: S
authors.lastname: Larrea
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España.
authors.forename: Laia
authors.initials: L
authors.lastname: Palència
authors.affiliation: Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España. Electronic address: gperez@aspb.cat.
authors.forename: Glòria
authors.initials: G
authors.lastname: Perez
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D000028:Abortion, Induced / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents; D004363:Drug Utilization; D005260:Female; D005865:Gestational Age; D006801:Humans; D007239:Infections; D007843:Latin America; D015735:Mifepristone; D016595:Misoprostol; D011177:Postal Service; D011247:Pregnancy; D012306:Risk; D012769:Shock / Q000453:epidemiology / Q000209:etiology; D017216:Telemedicine; D014592:Uterine Hemorrhage / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D000900:Anti-Bacterial Agents; D016595:Misoprostol; D015735:Mifepristone
keywords: Aborto inducido; Complicaciones; Complications; Induced abortion; Mifepristona; Mifepristone; Misoprostol; Telemedicina; Telemedicine