3. PRE-ABORTION EVALUATION
Updated June 2022 by Chelsea Faso MD, Mayra Hernandez Schulte, MD, and Caitlin Weber, MD, MS
This chapter will address history, physical exam, and testing prior to abortion to ensure that a patient is eligible and the chosen method is safe. The pre-abortion evaluation is focused on pregnancy dating and pertinent medical history. Pregnancy dating is usually done by asking a patient their last menstrual period (LMP). Depending on the setting, and if needed, this can be done with the addition of a bimanual exam or ultrasound (US). Although persons of childbearing age are typically healthy and eligible for outpatient abortion, this chapter will address when referral is preferred for safety.
CHAPTER LEARNING OBJECTIVES
Following completion of this chapter, you should be better able to:
- Use clinical findings to confirm intrauterine pregnancy and accurately date pregnancy
- Gather appropriate historical, physical exam, and lab information as needed to safely perform uterine aspiration or medication abortion in an outpatient setting, and know when to consult/refer
- Determine when US is useful in confirming an intrauterine pregnancy, and when further assessment is needed to evaluate a possible ectopic pregnancy or pregnancy of unknown location (PUL).
- List clinical, lab, and sonographic findings that constitute red flags for ectopic pregnancy
- Ultrasound Training Videos (University of Washington)
- Ultrasound Lecture Series: Obstetrics and Gynecology (AUIM)
READINGS / RESOURCES
- Paul et al (eds). Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care (Wiley-Blackwell, 2009)
- Chapter 6: Clinical Assessment and Ultrasound in Early Pregnancy
- Chapter 7: Medical Evaluation and Management
- Hendricks, E, MacNaughton, H, Mackenzie, M. First Trimester Bleeding: Evaluation and Management. Am Fam Physician. 2019 Feb 1;99(3):166-174.