Early medical abortion at home up to 12 weeks is safe, effective, and comparable to hospital care

Early medical abortion at home up to 12 weeks of pregnancy is safe, effective, and comparable to hospital care, finds a 5 year review of cases in Scotland, where this timeframe is legally permitted, and published online in the journal BMJ Sexual & Reproductive Health.

Researchers, from the Institute for Regeneration and Repair's Centre for Reproductive Health, conclude that it’s time to extend the current legal limit of 10 weeks to 12 weeks to enable women in the rest of the UK and Europe to choose this option.

During the COVID-19 pandemic, legislation was introduced throughout Scotland, England, and Wales to allow women to take both the drugs (mifepristone and misoprostol) required for a medical abortion at home, explain the researchers. Despite the World Health Organization (WHO) recommending that early medical abortion at home can occur safely in the first 12 weeks of pregnancy, legislation in England and Wales limits this to 10 weeks. 

Early medical abortion at home is legal in Scotland up to 12 weeks of pregnancy. The researchers therefore wanted to assess the safety and effectiveness of the procedure, when carried out between 10 and 12 weeks. They looked back at the outcome of abortions carried out between 10 and 12 weeks of pregnancy in hospital and at home in NHS Lothian in Scotland for the 5 years between 1 March 2020 and 31 March 2025. 

A total of 14,458 referrals were made to the abortion service during this period. Of these, 485 women (3.5%) were assessed as being between 10 and 12 weeks of pregnancy either by the date of their last period or by ultrasound scan. Of this group, 371 women opted for an early medical abortion, 258 (70%) of whom chose to induce abortion at  home, while the reset 113 (30%) opted for a surgical abortion in hospital. For both at-home and in hospital abortions, 97% of women achieved complete abortion. 

Three women were still pregnant after their initial treatment, all of whom were among those who had opted for a medical abortion at home. One of these women chose to continue with the pregnancy while the other two went on to have an abortion in hospital.

There were 4 cases of serious complications (heavy bleeding or infection) 1 month after the procedure, all of whom were among those who opted for medical abortion at home. None of these women required critical care.

Women who had had a medical abortion at home were more likely to make unscheduled contact with either the hospital gynaecology department or the abortion clinic than those who had the procedure in hospital, but this was largely telephone advice, with 11% (28/258) of the abortion at home group requesting advice that could be exclusively managed over the phone. A further small number of women required a return visit to the abortion clinic,7% of the home group vs 2% of the hospital group. However, the paper's authors offer an explanation for the higher rate of follow up advice: Given that those who have an [early medical abortion] in hospital will have contact with a healthcare professional throughout their procedure, it is understandable that those who have [early medical abortion] at home would be more likely to contact the abortion service with questions or concerns.

The study contained a relatively small number of patients, and only one case of haemorrhage, which researchers say was unlikely to have been altered by admission to hospital. 

Lead author Jacqueline Quinn was supported by a grant from the Canadian Institutes for Health Research.