SUMMARY POINTS
Skills
- Accurate pregnancy dating is a key skill in pre-abortion evaluation.
- Pregnancy duration is accurately assessed by a person’s LMP and when unavailable or unreliable, by a series of questions and/or ultrasound (Ralph 2021).
- Ultrasound (US) can aid in pregnancy dating and the detection of abnormal pregnancy. It is important to recognize and understand management strategies for pregnancy of unknown location (PUL), ectopic pregnancy and early pregnancy loss (EPL).
Safety
- People with chronic health conditions should generally continue their regular medications through the abortion process, with rare modifications, as needed.
- Pre-abortion evaluation may reveal conditions impacting a person’s eligibility for outpatient medication or procedural abortion, or indicate need for a higher level of care.
- Higher weight is not associated with increased procedural abortion complications, and should not necessitate transfer or delay (Benson 2016, McMahon 2025).
- 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.
Role
- Clinicians should strive to listen to the people they are providing care for and incorporate their values, experiences, and preferences wherever possible.
- Streamlining or avoiding unnecessary labs and visits can improve people’s access and experience, without jeopardizing safety. This is especially important in restrictive environments, or where initiation of care and follow-up may be occurring in different locations.