ULTRASOUND WITH MEDICATION ABORTION

Once pregnancy is confirmed by a urine hCG, pregnancy dating should be established. When pregnancy dating cannot be reasonably determined by other means, ultrasound should be used (NAF CPG 2020). Its use is not a requirement for medication abortion provision (NAF, SFP, ACOG, FDA, Ipas, WHO). Studies demonstrate the safety of eliminating routine ultrasound from medication abortion care (Raymond 2018, Schonberg 2014, Clark 2007, Bracken 2011). This helps streamline care, and avoid cost and delays.

Ultrasound Indications for Medical Abortion

(Adapted from RHEDI, NAF)

Pre-Abortion Post-Abortion
  • Possible pregnancy dating >70 days1
  • Size/date discrepancy on bimanual
  • Provider uncertainty with exam
  • Uncertain LMP (irregular menses, or no menses after delivery, abortion, hormonal contraceptive use)
  • Adnexal mass or pain
  • History of, risk factors for, or current symptoms or signs suggestive of ectopic pregnancy
  • History not consistent with successful medication abortion (no or scant bleeding or cramping)
  • Patient still feels pregnant
  • If used, serum hCG not declining appropriately
  • Provider uncertainty with history
  1. Data supports accuracy of pregnancy dating by LMP alone with low rates of over- and under-estimation through mid-first trimester (<63 days LMP). This can likely be reasonably extended to include pregnancies to 70 days and beyond, depending on your practice setting, though explicit evidence is lacking.
SUCCESSFUL ABORTION

The absence of the pregnancy (gestational sac or embryo depending the US findings prior to MAB) and the presence
of thickened endometrial stripe are typical after successful medication abortion. The size of the endometrial stripe has no clinical significance in assessment of success of a medication abortion, and incorrect interpretation can lead to unnecessary intervention (SFP 2014).

SUCCESSFUL ABORTION
PERSISTENT GESTATIONAL SAC
AFTER MEDICATION ABORTION

This transvaginal ultrasound shows the presence of an empty gestational sac. Patients can choose their preferred management option: waiting for spontaneous completion, repeat misoprostol (expels GS > 60% of time (Reeves 2008)), or an aspiration procedure. (Or repeat mifepristone and misoprostol but minimal data on efficacy).

PERSISTENT GESTATIONAL SAC AFTER MEDICATION ABORTION

 

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