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.
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.
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.