SUMMARY POINTS

SKILL

 

  • Accurate gestational age assessment is a key component of the pre-procedural evaluation and prevents complications associated with underestimation.
  • If clinical dating is uncertain, ultrasound can help to more accurately estimate the gestational age of an intrauterine pregnancy. It may also provide crucial information when an evaluation for ectopic pregnancy or early pregnancy loss is indicated.

 

SAFETY

 

  • If relying on ultrasound records from the chart, confirm the date of exam to calculate current gestational age.
  • If ectopic pregnancy is suspected, diagnostic testing will likely include pelvic exam, serial serum hCG levels, transvaginal US, and possibly diagnostic aspiration. A “normal” rise or fall in hCG levels alone is not sufficient to exclude an ectopic.
  • The pre-procedural medical evaluation may reveal conditions that warrant further management or that modify the optimal timing or setting for the uterine aspiration.
  • Patients with chronic medical conditions planning a first-trimester uterine aspiration should be encouraged to continue their regular medications, with rare modifications, as needed.

 

ROLE

 

  • Providers in settings with limited ultrasound access can safely provide medication abortion or aspiration by clinical dating with ultrasound as needed.

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