Do I Need an Ultrasound Examination for Abortion With Pills?

Abortion pills are used to terminate a pregnancy in the first trimester as an alternative to invasive methods. With the increasing use of telemedicine services, postal mail delivery of abortion pills, and self-managed abortion, the importance of in-person clinic visits and ultrasound examinations is being questioned.

The use of abortion pills without pelvic examination or ultrasonography is safe and efficient in 95% of cases, a recent report from the University of California states. This information is beneficial in increasing access to abortion care, especially for people with low income and limited access to healthcare.

Ultrasound imaging or ultrasonography (USG) is one of the examination methods used during in-person clinic visits, with a screening effectiveness rate of 93-98%. This method helps to determine the patient's eligibility for medical abortion and if abortion with pills is a suitable choice. Ultrasound imaging is also helpful during the follow-up period after the abortion has happened.

Let's explore the conditions suitable for medical abortion to understand who and when could benefit from a USG.

How do abortion pills work?

In the first trimester, the primary method for medical abortion is a combination of mifepristone and misoprostol. If mifepristone is unavailable, a misoprostol-only regimen also could be used.

Mifepristone disrupts the pregnancy-maintaining effects of progesterone, and misoprostol softens the cervical tissue and induces uterine contractions to evacuate the pregnancy material.

Abortion pills – is it a suitable solution?

Abortion with pills is considered a safe method for terminating intrauterine pregnancies. The key word here is “intrauterine”, meaning if the embryo is located anywhere outside the womb cavity, the use of abortion pills may have severe and life-threatening complications.

At the same time, the week of the pregnancy is another crucial concept to be considered for medical abortion.

In 2016 the FDA approved the supplemental use of mifepristone as an abortion pill in the first trimester, i.e., in pregnancies up to 70 days (10 weeks) of gestation. According to World Health Organization (WHO) recommendations, this limit is 12 weeks.

It is important to remember that the gestation week should be calculated from the first day of the last menstrual cycle, meaning the last time your period started.

Ultrasound examination – how does it help?

An ultrasound examination can be helpful to determine certain factors about the pregnancy. It can detect where the pregnancy is located and if it is within recommended age limits.

Confirmation of intrauterine pregnancy

If the embryo is located outside the uterine cavity, this condition is known as an ectopic pregnancy. Ectopic pregnancies cannot be aborted with abortion pills. If the condition is missed and left untreated, the ectopic organ may rupture, resulting in internal bleeding and severe life-threatening consequences.

Ultrasound examination helps confirm the location of the embryo, in other words, if implantation has happened inside the uterine cavity. This confirmation is not required in all cases. However, it is recommended in women with an increased risk for ectopic pregnancies.

According to the reports, 7 to 20 women per 100,000 cases use abortion pills while their ectopic pregnancies remain undetected. Although very rare, if missed, this could have life-threatening consequences.

Confirmation of gestational age

Since there is a recommended gestational age limit for medical abortion, it is important to confirm the pregnancy week.

In most cases, the last menstrual period accurately estimates the pregnancy week. However, women with the polycystic ovarian syndrome (PCOS), hormonal imbalances, and receiving certain medications may have irregular menstrual cycles.

In these cases, ultrasound might help determine the exact gestational age, informing whether a woman is suitable for abortion with pills.

Interestingly, the literature review suggests that 2.5 to 11.8% of women eligible for abortion with pills based on their last menstrual period were ineligible when examined with ultrasonography.

Follow-up after abortion

After abortion pills have been administered, ultrasonography helps confirm that the pregnancy was terminated successfully.

The long-standing practice recommended an ultrasound examination after a medical abortion. However, especially after the COVID-19 era, other follow-up methods have been prioritized to minimize additional travel to healthcare facilities.

At the same time, women using abortion pills should be informed about the possible signs of complications, such as retained pregnancy tissue, bleeding, infections. The presence of complications indicates that healthcare providers should be contacted without delay.