Early medical abortion at home up to 12 weeks found to be safe, effective, 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 five-year review of cases in Scotland, where this timeframe is legally permitted. The review was published online in the journal BMJ Sexual & Reproductive Health.

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, conclude the researchers.

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.

But despite the World Health Organization 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, they add.

But early medical abortion at home, up to 12 weeks of pregnancy, is legal in Scotland, and the researchers therefore wanted to assess the safety and effectiveness of the procedure when carried out between 10 and 12 weeks.

They therefore 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 five years between 1 April 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 rest, 113 (30%), opted for a surgical abortion in hospital.

The proportion of those achieving complete abortion was the same in both groups: 97%.

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

And women who had had a medical abortion at home were significantly more likely to make unscheduled contact with either the hospital gynecology department or the abortion clinic than those who had the procedure in hospital: 59/258 (23%) compared with 10/113 (9%).

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. This compares with 4% (5/113) of the hospital group.

A further small number of women required a return visit to the abortion clinic:19/258 (7%) of the home group vs. 2/113 (2%) of the hospital group.

“Given that those who have an [early medical abortion] in hospital will have contact with a health care 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,” say the researchers.

Acknowledging the small number of serious complications among those who opted for a medical abortion at home, the researchers comment that this is a rare complication among women who are less than 20 weeks’ pregnant.

“Our study contained a small number of patients, with only one case of hemorrhage that presented one month following abortion with chronic bleeding, and so admission to hospital for [early medical abortion] is unlikely to have altered this,” they explain.

They acknowledge that the number of cases they looked at was small, reflecting the small number of patients who present after 10 weeks.

Nevertheless, they go on to say, “These findings are akin to those reported in studies of [early medical abortion] below 10 weeks’ gestation in both home and hospital settings. This demonstrates that [early medical abortion] at home between gestations of 10 and 12 weeks is highly effective and safe.”

And they conclude, “In line with WHO guidance, action is needed to extend [early medical abortion] at home up to 11+6 [12] weeks to women across the rest of the UK and beyond.”