ULTRASOUND AS NEEDED WITH MEDICATION ABORTION
Once pregnancy is confirmed by a urine hCG, pregnancy dating should be established. When pregnancy dating cannot be reasonably determined by other means, US should be used (NAF 2022). US use is not a requirement for MAB provision (NAF, SFP, ACOG, Ipas, WHO). Studies demonstrate the safety of eliminating routine US from MAB care (Raymond 2018, Schonberg 2014, Bracken 2011). This helps streamline care, and avoid cost and delays.
Limited Ultrasound Indications for Medical Abortion
(Adapted from RHEDI, NAF)
- Data supports accuracy of pregnancy dating by LMP alone with low rates of over- and under-estimation through mid-first trimester (<63 days LMP) (Kapp 2020).
The absence of the pregnancy (gestational sac or embryo depending on the US findings prior to MAB) and the presence of thickened endometrial stripe are typical after successful MAB. The size of the endometrial stripe has no clinical significance in assessment of success of a MAB in the absence of abnormally prolonged or heavy bleeding, and incorrect interpretation can lead to unnecessary intervention (SFP 2014).
|PERSISTENT GESTATIONAL SAC
AFTER MEDICATION ABORTION
This transvaginal ultrasound shows the presence of an empty gestational sac. Patients can choose their preferred management option: waiting for spontaneous completion, repeat misoprostol (expels GS > 60% of time (Reeves, 2008), or an aspiration procedure. (Or repeat mifepristone and misoprostol but minimal data on efficacy).