The Safety and Efficacy of a "No Touch" Abortion Program Implemented in the Greater Toronto Area During the COVID-19 Pandemic

Martha K Smith; Maya Biderman; Erin Frotten; Sarah Warden; Sheila Dunn; Robert Dmytryshyn; Julie G Thorne

doi:10.1016/j.jogc.2024.102429

The Safety and Efficacy of a "No Touch" Abortion Program Implemented in the Greater Toronto Area During the COVID-19 Pandemic

J Obstet Gynaecol Can. 2024 Mar 7;46(6):102429. doi: 10.1016/j.jogc.2024.102429. Online ahead of print.

Authors

Martha K Smith¹, Maya Biderman², Erin Frotten³, Sarah Warden⁴, Sheila Dunn⁴, Robert Dmytryshyn⁴, Julie G Thorne⁵

Affiliations

¹ Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON. Electronic address: marthak.smith@mail.utoronto.ca.
² Temerty Faculty of Medicine, University of Toronto, Toronto, ON.
³ Choice in Health Clinic, Toronto, ON.
⁴ Bay Centre for Birth Control, Women's College Hospital, Toronto, ON; Department of Family and Community Medicine, University of Toronto, Toronto, ON.
⁵ Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Bay Centre for Birth Control, Women's College Hospital, Toronto, ON; Sinai Health Systems, Toronto, ON.

PMID: 38458271
DOI: 10.1016/j.jogc.2024.102429

Abstract

Objectives: To evaluate the safety and efficacy of first-trimester "No Touch" medication abortion programs at 2 clinics in Toronto, Ontario during their early implementation in response to the COVID-19 pandemic.

Methods: This retrospective study included all patients who underwent virtual consultation for mifepristone-misoprostol medication abortion between April 2020-August 2022 at 2 reproductive health clinics. In response to the pandemic, "No Touch" abortion protocols have been developed that align with the Canadian Protocol for the Provision of Medical Abortion via Telemedicine. Records were reviewed for demographic information, clinical course, investigations required, confirmation of complete abortion and adverse events. The primary outcome was complete medication abortion, defined as expulsion of the pregnancy without requiring uterine aspiration.

Results: A total of 277 patients had abortions initiated in the "No Touch" or "Low Touch" care pathways and had sufficient follow-up to determine outcomes. Of these patients, 92.8% (95% CI 89.7%-95.8%) had a complete medication abortion (n = 257) and 76.1% (n = 159) remained "No Touch" throughout their care. Investigations were performed for 102 participants before or after their abortion, classifying them as "Low Touch". Nineteen patients (6.9%) underwent uterine aspiration. The rate of adverse events was low, with 1 case of a missed ectopic pregnancy and 1 patient requiring hospitalization for endometritis.

Conclusions: "No Touch" provision of mifepristone-misoprostol medication abortion care was safe and effective with outcomes comparable to previous studies. These results provide evidence for the efficacy and safety of a "No Touch" approach in the Canadian context, which has the potential to reduce barriers to accessing abortion care.

Keywords: COVID-19; abortion; mifepristone; pandemic; telemedicine; termination of pregnancy.