Introduction: Since 2020, legislation in Britain has allowed both mifepristone and misoprostol to be taken at home for early medical abortion (EMA). In England and Wales, legislation restricts this to 9+6 weeks, but in Scotland this is permitted up to 11+6 weeks. Data on the outcomes of EMA at home >10 weeks' gestation is limited and so we aimed to establish the safety and efficacy of this in comparison with EMA in a hospital setting.

Methods: We conducted a retrospective review from our abortion service in Edinburgh, Scotland of outcomes of EMA at home versus hospital between 10+0 and 11+6 weeks' gestation over the 5-year period April 2020-March 2025. The primary outcome was complete abortion rate. Secondary outcomes were rates of incomplete abortion, ongoing pregnancy and serious complications.

Results: A total of 371 EMAs occurred at this gestation (n=258 home, n=113 hospital). Complete abortion rates were not statistically significantly different between groups: 251/258 (97%) (95% CI: 94% to 99%) at home and 110/113 (97%) (95% CI: 92% to 99%) in hospital. Neither incomplete abortion rates (home: 4/258, 1.6%; hospital: 3/113, 2.6%) nor ongoing pregnancy rates (home: 3/258, 1.2%; hospital: 0/113, 0%) were significantly different between groups. There was one case of haemorrhage requiring transfusion and three cases of infection receiving intravenous antibiotics, all in the at home group.

Conclusions: EMA at home between 10+0 and 11+6 weeks has the same high efficacy and safety as when conducted in hospital. Action is needed to extend EMA at home after 10 weeks' gestation to women across the rest of the UK and beyond.