ULTRASOUND AS NEEDED WITH MEDICATION ABORTION

When pregnancy duration cannot be reasonably determined by other means, ultrasound should be used (NAF 2024). US use is not a requirement for MAB provision (NAF, SFP, ACOG, FDA, Ipas, WHO). Studies demonstrate the safety of eliminating routine US from MAB care (Bracken 2011, Raymond 2018, Schonberg 2014, Simons 2024). This streamlines care, enables telehealth MAB for areas where access is otherwise limited, and avoids cost and delays.

1. ^{Data supports accuracy of pregnancy dating by LMP alone with low rates of over- and under-estimation through mid- first trimester (<11 weeks LMP) (Kapp 2020, Simons 2024,).}

SUCCESSFUL ABORTION The absence of the pregnancy (gestational sac or embryo depending on the US findings prior to MAB, if completed) and the presence of thickened endometrial stripe are typical after successful MAB. The size of the endometrial stripe and / or presence of endometrial debris has no clinical significance in assessment of success of an MAB in the absence of abnormally prolonged or heavy bleeding, and incorrect interpretation can lead to unnecessary intervention (ACOG 2020).
PERSISTENT GESTATIONAL SAC AFTER MEDICATION ABORTIONThis transvaginal US shows the presence of an empty gestational sac. People can choose their preferred management option: wait for spontaneous completion, repeat misoprostol (expels gestational sac > 60% of time (Reeves 2008), repeat mifepristone and misoprostol, or an aspiration procedure.