3. PRE-ABORTION EVALUATION

^{Updated 2025 by Jasmine Stewart MD, MS, Innes Tounkel MD
and Caitlin Weber MD, MS}

This chapter addresses history, physical exam, and testing prior to abortion to ensure patient eligibility and safety. The pre-abortion evaluation is focused on pregnancy dating, pertinent health history and screening. Pregnancy dating is based on the first day of their last menstrual period (LMP). The addition of a bimanual exam or ultrasound (US) may be used as needed and available. Although people capable of pregnancy are typically healthy and eligible for outpatient abortion, this chapter addresses appropriate referral to higher levels of care for safety, acknowledging factors such as legally restrictive or resource-limited settings.

Chapter Learning Objectives

Following completion of this chapter, you should be able to:

• Confirm intrauterine pregnancy (IUP) and accurately assess pregnancy duration
• Gather appropriate history, exam, and lab information to safely provide medication or procedural abortion in an outpatient setting, and know when to consult/refer
• Determine when US or further assessment are needed to confirm an IUP, to evaluate for ectopic pregnancy or pregnancy of unknown location (PUL)
• List clinical, lab, and sonographic findings that constitute red flags for ectopic pregnancy
• Consider the pre-abortion evaluation within the context of local restrictions and resources

Videos

• Speculum Care without Stirrups (This is How I Teach Series: IERH)
• Ultrasound Training Videos (University of Washington)
• Ultrasound Lecture Series: Obstetrics and Gynecology (AIUM)
• Global Ultrasound Institute: Gyn POCUS (for members)
• NAF online US Modules (for members plus US sim training for member clinics)
• ISUOG Ultrasound Courses (for members)
• SonoSim Courses (for members)

Readings / Resources

• WHO Abortion Care Guidelines (2022): Chapter 3.3, Pre-abortion
• Hendricks E, MacNaughton H, Mackenzie M. First Trimester Bleeding: Evaluation and Management. Am Fam Physician, 2019
• ACOG Committee Opinion No 700: Methods for Estimating the Due Date, 2017.
• Gestational Dating (Ipas 2022)
• SFP Clinical Recommendation: Management of undesired pregnancy of unknown location and abortion at less than 42 days of gestation, 2024.
• National Abortion Federation (NAF) Clinical Policy Guidelines for Abortion Care, 2024
• Related Chapter Content: Chapter 8: EPL Classification and Terminology