DOI: 10.1111/1471-0528.
17521
A BST R AC TS
Top scoring abstracts –­RCOG World Congress 2023
A BORT ION C A R E
OP.0037 | Experiences of early medical abortion
clinicians adopting telemedicine during the Covid-­19
pandemic
Yvonne Neubauer1; Jeni Harden2; Nicola Boydell2
1
MSI Reproductive Choices, UK, London, UK; 2Usher
Institute, University of Edinburgh, Edinburgh, UK
Introduction: Early medical abortion (EMA) in England
involves the administration of mifepristone followed by
misoprostol 24–­48 h later, to end an unwanted pregnancy.
Abortion in Great Britain is regulated under the Abortion
Act 1967 which sets out the conditions and locations that
an abortion can take place. Since 2018, women were per-
mitted to self-­administer misoprostol at home after taking
mifepristone in a registered clinic. When the COVID-­19
pandemic developed in early 2020, temporary changes were
made to the Abortion Act 1967 to minimise the transmis-
sion of the virus. Women were able to self-­administer both
abortion medications at home following a telemedicine con-
sultation. These temporary changes were subsequently made
permanent in 2022.
Objective: To explore the experiences of abortion care nurses
and midwives in England transitioning from in-­person to
telemedicine early medical abortion care delivery during the
COVID-­19 pandemic.
Design: A qualitative study conducted through individual,
semi-­structured online interviews of a purposive sample of
nine nurses and midwives. The study was conducted as a
Master of Public Health dissertation, therefore a purposive
sample approach was adopted due to considerations around
resources and study duration.
Method: Participants were recruited from MSI Reproductive
Choices UK, a large independent abortion care provider in
England. A topic guide was used to support semi-­structured in-
terviews conducted via Microsoft Teams. Analysis was completed
using Braun & Clarke's reflexive thematic analysis method.
Results: Four themes were identified –­Preparation for
launch of the service, conducting the telemedicine con-
sultation, impact of telemedicine EMA and the future of
the service. Participants described the introduction of tel-
emedicine EMA as a sudden but necessary measure to com-
ply with COVID-­19 restrictions. Challenges encountered
© 2023 The Authors. BJOG An International Journal of Obstetrics and Gynaecology ©2023 RCOG
BJOG. 2023;130(Suppl. 2):3–228. 
by clinicians during the consultation included adjusting to
clinical decision making through remote safeguarding as-
sessments and without ultrasound scans. Participants ex-
pressed that telemedicine EMA had a negative impact on job
satisfaction although acknowledged perceived benefits for
women. Most participants felt that all clinics should deliver
the service instead of a handful of ‘Hubs’. Longer waits for
appointments and increase in complaints and clinical inci-
dents were attributed to the creation of telemedicine Hubs.
Conclusions: Clinicians were supportive of telemedicine
EMA becoming permanent due to the advantages to women
however, they missed the human connection associated with
in-­person consultations. A suggested area of future research
is to investigate strategies to improve clinician experience of
remote consultations.
EP.0146 | Abortion care in Britain: How can we
enhance the patient journey?
Maria Lewandowska1; Rachel Scott2; Rebecca Meiksin1;
Jennifer Reiter3; Natasha Salaria1; Patricia A. Lohr4; Sharon
Cameron5,6; Melissa Palmer1; Rebecca S. French1; Kaye
Wellings1
1
Faculty of Public Health and Policy, London School of Hygiene
& Tropical Medicine, London, UK; 2Faculty of Epidemiology
and Population Health, London School of Hygiene & Tropical
Medicine, London, UK; 3London Borough of Lambeth, London,
UK; 4Centre for Reproductive Research and Communication,
British Pregnancy Advisory Service, Stratford-­upon-­Avon, UK;
5
NHS Lothian, Chalmers Centre, Edinburgh, UK; 6Queen's
Medical Research Institute, University of Edinburgh MRC
Centre for Reproductive Health, Edinburgh, UK
Objective: Models of abortion care have changed sig-
nificantly in the last decade, most markedly during the
COVID-­19 pandemic, when the home management of early
medical abortion with the aid of telemedicine was approved.
Our study aimed to examine women's levels of satisfaction
with abortion care delivered in Britain, and their suggestions
for improvements.
Design: Qualitative, semi-­structured, in-­depth interviews
Method: A purposive sample of 48 women with recent (past
2–­8 weeks) experience of abortion was recruited between
July 2021 and August 2022 from independent sector and
NHS abortion services in Scotland, Wales, and England.
wileyonlinelibrary.com/journal/bjo | 3

4 |   
Interviews were conducted over phone or via video-­
conference software. Women were asked about their abor-
tion experience and for suggestions of any improvements
that could be made along their patient journey –­from help-­
seeking, the initial consultation, referral, the procedure to
aftercare. Data were analysed using the Framework Method.
Results: Participants were aged 16 to 43 years; forty had had a
medical abortion, and eight a surgical one. The majority were
satisfied with and appreciated the clinical care they received.
They valued the supportive, kind and non-­ judgmental
attitudes of abortion providers. A positive aspect mentioned
by many was the convenience brought by telemedicine
and remote care, allowing accessible and prompt home
administration of medical abortion. Recommendations for
improvements were centred around the following areas:
the availability of choice –­including choice of the mode of
delivery of clinical care, method of abortion and location
(home or clinic); greater correspondence between guidance
on what to expect and the actual abortion experience; timely
access to care; and increased emotional support from a range
of sources throughout the abortion process.
Conclusions: Changes in abortion provision of the
magnitude of those introduced before and during COVID-­19,
would normally warrant a robust evidence base to inform
healthcare services. Given that this was unfeasible during
the pandemic because of the need for a rapid response,
our study contributes to the necessary body of evidence to
inform optimal future provision.
EP.0222 | RCOG Making Abortion Safe Programme:
Healthcare professionals advocating for quality abortion
care
Nia Sheppard; Suzanna Bright
RCOG, London, UK
Objective: Quality abortion care is a WHO listed essential
health service [1], and should be; effective, efficient, accessible,
acceptable, equitable and safe. However quality abortion care
remains contingent on legal, regulatory, policy, socio-­economic
and socio-­cultural systems, which in the majority of contexts
interact to create barriers to access. As a result, an estimated
45% of all abortions between 2010 and 2014 were unsafe [2].
Design: Recognising that obstetricians and gynaecologists,
and affiliated health professionals (HCPs), are uniquely
placed as advocates, the RCOG designed a 3-­year multi-­
country programme to advocate for improved access to
quality abortion care.
Method: Over 60 Sexual and Reproductive Health and
Rights “Champions” were appointed from a self-­selected
pool of HCPs from across Rwanda, Zimbabwe, Nigeria,
Sudan and Sierra Leone. Champions were supported to
analyse their abortion care ecosystem and develop unique
advocacy plans to tackle barriers to access. Implementation
was over 2 years with monthly review and quarterly cross-­
country learning meetings held online.
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ABSTR​ACTS​
Results: Common themes identified for advocacy across
the countries were; awareness of the grounds permit-
ted to provide abortion amongst HCPs, use of national
guidelines and ‘best practice’ papers; inclusion of abor-
tion care in medical curricular and in-­service trainings
and addressing abortion related stigma. Key results from
the project included; use of our ‘best practice’ papers to
inform the development of new national abortion guide-
lines by the Rwandan Ministry of Health, dissemination
of over 2000 copies of the national guidelines in Nigeria
to HCPs leading to greater awareness and discussion of
the guidelines at various platforms, and recognition from
the Zimbabwean Ministry of Health of the importance of
a multi-­sectoral approach to the delivery of quality abor-
tion care.
Conclusion: HCPs who are committed to improving wom-
en's health through access to quality abortion care are ideally
placed advocates as they provide a legitimate and respected
voice to both policy makers and communities. They can be
instrumental in identifying and developing strategies to
address barriers to care. Through collaborating with these
professionals to coordinate efforts and providing technical
support, guidance and financing for their work, professional
bodies can positively contribute towards efforts to achieve
global equity in access to abortion care.
[1] maintaining essential health services: operational
guidance for the COVID-­ 19 context, interim guidance,
1 June 2020 (https://www.who.int/publications/i/item/
WHO-­2019-­nCoV-­essential-­health-­services-­2020.1).
[2] Ganatra B et al., Global, regional, and subregional
classification of abortions by safety, 2010–­14: estimates from
a Bayesian hierarchical model, Lancet, 2017, published online
Sept. 27. http://dx.doi.org/10.1016/S0140-­6736(17)31794-­4.
EP.0232 | Access to formal abortion services and
demand for medical abortion in Turkey
Bilge Eylem Dedeoglu1; Hazal Atay2; Ugur Berkay
Balkanci3; Efekan Sadak4; Rebecca Gomperts5
1
University Hospital Southampton, Southampton, UK;
2
Sciences Po, Paris, France; 3University of Minnesota,
Minnesota, USA; 4Koc University, Istanbul, Turkey; 5The
Women on Web International Foundation, Ontario, Canada
Objective: To identify the barriers in accessing formal abor-
tion services in Turkey and understand motivating factors
for requesting a telemedicine-­mediated medical abortion
Design: The Women on Web (WoW) is an international
organisation that provides telemedicine-­mediated medical
abortion service. Women who sought medical abortion via
the WoW website filled a consultation survey that consisted
of 25 questions. On the survey, they were also asked for their
consent to partake in research. The data from all consented
users were collected. Following the survey, all participants
were also given user-­initiated follow-­up option to engage in
discussion on their abortion experiences or expectations.

A​B ST​R ACTS
The qualitative data from the participants who initiated this
track were collected for content analysis.
Method: 620 women who were over the age of eighteen, lived
in Turkey and consented to partake in research between 1
January 2013 and 12 October 2020 via their consultation
surveys were included. A cross-­ sectional analysis of
the surveys was conducted on SAS 9.4. Following that,
qualitative data from 138 women who engaged with user-­
initiated follow-­up were subjected to content analysis until
overarching themes were saturated.
Results: 58.39% of the participants were not using any
contraceptives at the time of conception. While 59.68% of
women mentioned that they just can't have a child at this
point of their life, financial constraints (49.84%), wanting
to finish school (31.77%), and being too young (31.29%)
were among other most cited reasons to seek abortion.
The barriers to formal abortion care were reported as cost
(48.31%), need to keep the abortion secret from partner or
family (42.69%), and stigma (37.07%). The content analysis
of participants' experiences with formal abortion care
demonstrated decreasing availability of abortion services in
public and private sectors, de-­facto privatisation of abortion,
spousal permit requirement and concerns over physicians'
approach to confidentiality and medical ethics of abortion
as barriers while their dissatisfaction with available abortion
methods and potential of medical abortion for autonomy
motivated women to seek medical abortion.
Conclusions: Despite relatively liberal regulations in Turkey,
this study demonstrated that access to formal abortion
services remains tenuous for many women due to limited
availability of abortion providers, practitioners' approach
to confidentiality, de-­ facto privatisation of abortion and
arbitrary pricing strategies. Further research into the
deviation in abortion services from the regulations should be
considered to explore the factors behind this phenomenon at
macro (institution) and micro (practitioner) levels.
EP.0303 | Modified regimen for mid-­trimester
medical termination: Assessment of safety and
effectiveness
Aleksandra Dunin-­Borkowska1; Eleanor Sein2; Angela
Yulia2; Tarek El Shamy2
1
Imperial College London, London, UK; 2Chelsea and
Westminster Hospital NHS Foundation Trust, London, UK
Objective: Up to one in six terminations of pregnancy occur
beyond the first trimester, often due to fetal anomalies.
Given the significant psychological and physiological impact
of terminations, particularly beyond the first trimester, there
is a need for an effective, safe and streamlined process. The
current protocol for medical terminations recommended
by RCOG and NICE is 200 mg of mifepristone orally, fol-
lowed by 800 μg misoprostol vaginally and up to four sub-
sequent doses of 400 mg of misoprostol orally. Concerns
regarding the risk of uterine rupture (1 in 1000) at these high
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   | 5
misoprostol doses have prompted the consideration of lower
doses. The aim of this study is to review the safety and ef-
fectiveness of a modified regimen for mid-­trimester medi-
cal terminations at Chelsea and Westminster Hospital NHS
Foundation Trust.
Design: A retrospective study of all women undergoing
medical termination of pregnancy between 1st January 2019
and 31st April 2022 under clause E.
Method: A total of 82 women fulfilled the inclusion criteria.
Three women aborted spontaneously following feticide. The
remaining 79 patients were started on a regimen of 200 mg
of mifepristone orally, followed by 200 μg of misoprostol
vaginally (100 μg in women with previous c-­ sections or
beyond 26 weeks gestation) and then up to four 100 μg
misoprostol doses. Where one cycle was unsuccessful,
a consultant review occurred. Data on demographics,
pregnancy-­ related factors, adherence to protocol and
outcomes were collected.
Results: One woman delivered following mifepristone alone.
Of the 78 women given misoprostol, 93% (n = 73) delivered
within 48 h and 97% (n = 76) within 72 h of the first dose. Two
women took over three days to deliver, involving multiple
cycles with rest times. A total of 23% (n = 18) required
surgical intervention, with 89% (n = 16) of these for retained
placental tissue. 36% of women (n = 28) experienced side
effects or adverse events, however, most were known side
effects of misoprostol. The median blood loss was 150 mL.
There were no cases of uterine rupture. These results are
comparable to the outcomes achieved using current RCOG/
NICE recommendations.
Conclusion: The implementation of a modified regimen
demonstrated comparable clinical effectiveness and a re-
duced risk of major complications compared to regimens
using higher misoprostol doses. However, it was associated
with prolonged hospital stay and the need for additional cy-
cles in some women. This study shows that use of a modified
regimen is an effective and safe option that could be offered
to women and can be continued in our trust.
A DOL E SCE N T GY NA E COL OGY
OP.0005 | Knowledge attitude and practice of
Tunisian midwives regarding teenage pregnancy
Nesrine Souayeh1,2; Hana Smida1,2; Hajer Bettaieb1,2;
Hadhami Rouis1; Najeh Hsayaoui1,2; Chaouki Mbarki1,2;
Imen Chaieb3
1
Ben Arous Regional Hospital, Gynecology and obstetrics
department, Ben Arous, Tunisia; 2University Tunis Elmanar,
Faculty of medecine, Tunis, Tunisia; 3Faculty of medicine of
Sfax, Sfax, Tunisia
Objective: Teenage pregnancy is quite common, given that
11% of childbirths worldwide involve teenage girls. It is con-
sidered as a particular situation which raises problems and is