Abstract：
OBJECTIVE: 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.
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.
摘要：
目的：评估多伦多两家诊所的妊娠早期“NoTouch”药物流产计划的安全性和有效性，安大略省在应对COVID-19大流行的早期实施期间。
方法：这项回顾性研究包括所有在2020年4月至2022年8月期间在两家生殖健康诊所接受米非司酮-米索前列醇药物流产虚拟咨询的患者。为了应对大流行，已经制定了“NoTouch”堕胎协议，与加拿大通过远程医疗提供医疗堕胎的协议保持一致。对人口统计信息的记录进行了审查，临床课程，需要调查，完全流产和不良事件的确认。主要结果是完全药物流产，定义为在不需要子宫抽吸的情况下驱逐妊娠。
结果：共有277名患者在“NoTouch”或“LowTouch”护理路径中进行了流产，并进行了充分的随访以确定结果。在这些病人中,92.8％（95CI89.7％-95.8％）完全药物流产（n=257），76.1％（n=159）在整个护理过程中保持“NoTouch”。在堕胎之前或之后对102名参与者进行了调查，将它们分类为“低接触”。19例患者（6.9%）接受了子宫抽吸术。不良事件发生率较低，其中1例漏诊异位妊娠和1例因子宫内膜炎需要住院治疗的患者。
结论：“NoTouch”提供米非司酮-米索前列醇药物流产护理是安全有效的，其结果与以前的研究相当。这些结果为“不接触”方法在加拿大的有效性和安全性提供了证据，这有可能减少获得堕胎护理的障碍。
方法：这项回顾性研究包括所有在2020年4月至2022年8月期间在两家生殖健康诊所接受米非司酮-米索前列醇药物流产虚拟咨询的患者。为了应对大流行，已经制定了“NoTouch”堕胎协议，与加拿大通过远程医疗提供医疗堕胎的协议保持一致。对人口统计信息的记录进行了审查，临床课程，需要调查，完全流产和不良事件的确认。主要结果是完全药物流产，定义为在不需要子宫抽吸的情况下驱逐妊娠。
结果：共有277名患者在“NoTouch”或“LowTouch”护理路径中进行了流产，并进行了充分的随访以确定结果。在这些病人中,92.8％（95CI89.7％-95.8％）完全药物流产（n=257），76.1％（n=159）在整个护理过程中保持“NoTouch”。在堕胎之前或之后对102名参与者进行了调查，将它们分类为“低接触”。19例患者（6.9%）接受了子宫抽吸术。不良事件发生率较低，其中1例漏诊异位妊娠和1例因子宫内膜炎需要住院治疗的患者。
结论：“NoTouch”提供米非司酮-米索前列醇药物流产护理是安全有效的，其结果与以前的研究相当。这些结果为“不接触”方法在加拿大的有效性和安全性提供了证据，这有可能减少获得堕胎护理的障碍。
