The follow-up appointment should be scheduled 3 to 7 days after taking misoprostol (MISO), and more than one follow-up appointment may be needed. The SOGC’s protocol on the provision of medication abortion by telemedicine advises 7 days[7], but some prescribers schedule the follow-up appointment as early as 3 days after MISO administration to avoid loss-of-contact and assess serum bhCG level. The actual practices depend on prescribers’ judgment and experiences.
During the virtual follow-up, prescribers should[7]:
- Review abortion experience and progress with patients, including dates of taking medication, side effects, bleeding pattern, pain, occurrence of expulsion, and any current pregnancy symptoms.
- Advise an urgent assessment or emergency visit if signs of ectopic pregnancy, pelvic infection, heavy bleeding, or excessive pain exist.
- If history suggests failed abortion or ongoing pregnancy: obtain ultrasound and consider an additional dose of MISO or procedural abortion.
- If history suggests successful abortion, no warning signs, and no current symptoms of pregnancy, normal bleeding and pain: arrange the blood test to confirm serum bhCG level if the appointment is in-person or instruct the patient to perform qualitative urine pregnancy test.
Serum bhCG[4]: If the serum bhCG level drops by >50% at Day 3 after MISO or 80% at Day 7-14 after MIFE / MISO administration, the successful completion of abortion is confirmed and no further appointment is needed. Ultrasound should be ordered if 14 days have passed and a drop by 80% has not been reached.
Urine bhCG[7]:
- Offer to discuss contraception options and provide emotional support if needed. Resources for emotional support include:
- Exhale, a talk-line that provides emotional support, resources and information after abortion.
- All-Options, a talk-line to discuss past or current experience with abortion, adoption and parenting for people in Canada and the United States (1-888-493-0092).
