Early Options: Module 4 - The Role of Ultrasound, hCG Assays, and Clinical Assessment in Medical Abortion

Early Options - A Provider's Guide to Medical Abortion

The on-line CME post-test will follow this module. However, we strongly urge you to print out the CME Post-Test Questions before starting this module to help guide you through the material.

Objectives
Upon completion of this module, you should be able to:
1. Describe the sonographic signs of early intrauterine pregnancy
2. Review clinical, sonographic, and laboratory methods to estimate gestational age and assess medical abortion outcomes
3. Identify sonographic findings pre- and post-medical abortion
4. Discuss the use of ultrasonography in the diagnosis of abnormalities during early pregnancy

Introduction
Clinicians who provide medical abortion must be able to diagnose pregnancy and estimate gestational age. Accurate estimation of gestational age is essential, as the efficacy of the FDA-approved mifepristone/misoprostol regimen and of methotrexate/misoprostol regimens for medical abortion decreases as the pregnancy advances beyond 49 days' gestation.¹ Numerous studies have established the continued high efficacy of mifepristone in combination with vaginal misoprostol through 63 days' gestation.²^,3 (Note: Although numerous studies have established their safety and efficacy, the combination of methotrexate and misoprostol and the use of vaginal misoprostol with mifepristone are not FDA-approved for medical abortion.)

Clinical evaluation to establish the diagnosis and dating of pregnancy includes a pertinent history, physical examination, pregnancy testing, and, possibly, sonographic imaging. While medical abortion researchers and many providers in the United States have routinely used ultrasound for gestational dating, experienced medical abortion providers in other countries have reported high rates of safety and efficacy primarily using clinical parameters for dating.

Technologies permitting the early diagnosis of pregnancy, such as sensitive human chorionic gonadotropin (hCG) assays and transvaginal ultrasound, have significantly advanced reproductive health care. This module addresses the role of these diagnostic modalities in evaluating patients' eligibility for medical abortion, monitoring the procedure, and detecting abnormal pregnancy.

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Proceed to Clinical Diagnosis of Early Pregnancy.

References for this module