The following assessments should be carried out[7,19]:
- Review pregnancy options counselling.
- Establish pregnancy and gestational age.
- Review date of last menstrual period (LMP) and date of positive qualitative pregnancy test.
- Review relevant medical history, including recent hormonal contraception and risk factors and signs of ectopic pregnancy.
- Exclude contraindications.
- Assess the need for an ultrasound to determine gestational age and the location of pregnancy[5]:
- According to [SOGC’s protocol on medication abortion](C14) via telemedicine, ultrasound should be obtained if LMP is uncertain, LMP is over 70 days, and the signs, symptoms and risk factors of ectopic pregnancy (EP) are present.
- Medication abortion performed without ultrasound is, by definition, pregnancy of unknown location and should be managed accordingly. Though the risk of unrecognized EP is low, close follow-up is required to ensure completion of the medication abortion.
- Assess the need for blood work to measure hemoglobin[7]:
- According to Health Canada, hemoglobin should be over 9.5 g / dL before starting MA.
- Screen patients for increased risk of anemia through a detailed medical history.
- If patients are suspected to have an increased risk of anemia, complete blood count is indicated. Otherwise, measuring hemoglobin is unnecessary.
- Assess the need for blood work to determine Rh status (Rh)[7]:
- As explained elsewhere, guidelines on Rh status have been updated and vary between organizations.
- According to the SOGC’s Guideline on Prevention of RhD Alloimmunization published in 2024, for non-sensitized Rh D-negative individuals who have experienced threatened, spontaneous or induced abortion after 12 weeks gestation, administration of 300 μg of Rho(D) immune globulin is suggested.
- The [National Abortion Federation](C6), the [Society of Family Planning](SFP1) and the [World Health Organization](WHO1) all recommend Rh testing and administration for patients who are 12 weeks gestation or beyond, but not for patients who are under 12 weeks LMP.
- Assess the need for STI testing[7]:
- Offer testing for chlamydia and gonorrhea if patients come to office.
- Otherwise, evaluate the risk of STIs and consider remote testing if risk factors are present, and discuss the potential need for antibiotic treatment.
