SUMMARY POINTS

Accurate pregnancy dating is a key component of the pre-abortion evaluation.
Using a patient’s last menstrual period (LMP) is accurate, with low rates of both under- and over- estimation up to 8 weeks LMP (Kapp 2020, Ipas 2021, Macaulay 2019, Raymond 2015, Schonberg 2014). Asking additional questions may improve this accuracy (Ralph 2021). When pregnancy dating cannot be assessed using LMP, a series of questions and/or ultrasound can be used (Ralph 2021).
Providing medication abortion (MAB) using medical history alone has high rates of safety and efficacy up to 10-11 weeks LMP (Upadhyay 2022).
US aids in pregnancy dating and the detection of abnormal pregnancy. It is important to recognize and understand management strategies for pregnancy of unknown location (PUL), including differentiation and management of potential 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.
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 US, and / or diagnostic aspiration. A “normal” rise or fall in hCG levels alone is insufficient to exclude ectopic pregnancy.
Increasing access by decreasing barriers to low risk medication abortion and abortion by vacuum aspiration is a critical way to increase safety.

ROLE

Trusting that patients are the experts in their bodies and their pregnancies can improve provider confidence in eliminating unnecessary diagnostics prior to an abortion.
Streamlining or avoiding unnecessary labs and visits can improve access and patient experience, without jeopardizing safety. This will be even more important in environments with legal restrictions or bans.