ULTRASOUND WITH MEDICATION ABORTION

The use of ultrasound is not a requirement for the provision of medication abortion (NAF, SFP, ACOG, ARHP, AAFP, FDA, Ipas, WHO ), and recent trials demonstrate the safety of eliminating routine ultrasound from pre- and post-medication abortion care.

Ultrasound As-Needed Indications to Inform Clinical Decision-Making (RHEDI)
Pre-Abortion Post-Abortion
  • EGA >9 weeks by LMP
  • Size/date discrepancy
  • Provider uncertainty with exam
  • Uncertain LMP (irregular menses, or no menses after delivery, abortion, contraceptive initiation)
  • Adnexal mass or pain
  • History of previous ectopic pregnancy 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
    (i.e., <50% decrease from baseline 48 hours after mifepristone or <80% after 1 week)
  • Provider uncertainty with history

 

SUCCESSFUL ABORTION
The absence of the pregnancy (gestational sac or embryo
depending the US findings prior to MAB) and the presence
of intrauterine debris 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).
PERSISTENT GESTATIONAL SAC
AFTER MEDICATION ABORTION

This transvaginal ultrasound shows the presence of an
empty gestational sac. A persistent gestational sac,
embryo, or fetus indicates an incomplete abortion.
Management options include waiting for spontaneous
completion, administering a repeat dose of misoprostol,
or performing an aspiration procedure.
Images courtesy of Fjerstad.

 

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