SUMMARY POINTS

SKILL

  • Accurate pregnancy dating is a key component of the pre-abortion evaluation.
  • Using a patient’s last menstrual period is accurate, with low rates of both under- and over- estimation to mid-first trimester (Raymond 2015, Schonberg 2014, Bracken 2011). When pregnancy dating cannot be determined by last menstrual period, ultrasound can be used.
  • Ultrasound aids in pregnancy dating and the detection of abnormal pregnancy including ectopic pregnancy and early pregnancy loss.

SAFETY

  • Patients with chronic medical conditions planning an abortion should be encouraged to continue their regular medications, with rare modifications, as needed.
  • The pre-abortion evaluation may reveal conditions that determine a patient’s eligibility for outpatient medication or aspiration abortion or indicate need for a higher level of care.
  • If ectopic pregnancy is clinically suspected, diagnostic testing may include pelvic exam, serial serum hCG levels, transvaginal ultrasound, and diagnostic aspiration. A “normal” rise or fall in hCG levels alone is not sufficient to exclude an ectopic pregnancy.

ROLE

  • Removing unnecessary labs and visits can improve access and patient experience, without jeopardizing safety.
  • Trusting that patients are the experts in their bodies and their pregnancies can improve provider confidence in eliminating unnecessary diagnostics prior to an abortion.

License

EARLY ABORTION TRAINING CURRICULUM Copyright © 2020 by UCSF Bixby Center for Global Reproductive Health. All Rights Reserved.