Medication Abortion Checklist

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DETERMINE ELIGIBILITY

Confirm pregnancy

Rule out medical contraindications

Determine gestational age ≤ 84 days

LMP
Bimanual exam if indicated
Sonography if indicated

PREPARE FOR THE ABORTION

Counsel on medication abortion process

Document patient’s preferred contact info/method

Rh testing and RhIG (e.g., RhoGAM) administration (for Rh negative patients) not needed for patients <70 days and may be waived before 84d.

DISCUSS LOGISTICS

Assist patient in determining optimal timing and location for taking each medication

Mifepristone in office or out of office
Misoprostol (24‒48h after mifepristone if buccal use, 6‒72h if vaginal use)
Offer patient a note for work/school absence

Discuss whether patient has a safe/comfortable place to bleed and cramp, with access to a bathroom
Review potential work/school/childcare conflicts

GIVE MEDICATION

Dispense or prescribe:

Mifepristone 200mg for oral use
Misoprostol 800mcg for buccal or vaginal use
Document medication lot#/exp/NDC in chart
A second 800mcg dose misoprostol 4h after 1st dose, may be offered (prescribed or dispensed) for GA 64‒70 days; recommended for GA 71‒84 days. May also be given/prescribed to all patients as backup.

Prescribe:

Ibuprofen 800mg (1st dose 30 min before miso, then 400‒800mg q6–8h prn)
As needed, offer acetaminophen with narcotic (5/325mg, 1–2 tabs q6h prn) and anti-emetic such as promethazine (25mg q6h prn nausea)

Administer:

RhIG (if recommended or per patient preference)

PROVIDE DOCUMENTATION

Mifepristone Patient Agreement and Medication Guide

Mandated reporting form (per city or state protocol) and required consent forms (facility dependent).

Check for additional steps required by your state

Information for Patients after Medication Abortion

Order initial serum HCG (if patient chose this method for follow-up) to be drawn on day of mifepristone

CONFIRM ABORTION IS COMPLETE

Confirmation options:

Follow-up questions to ask in-person or remotely:

Did the patient take the medications as scheduled?
How much bleeding did they have? Did they pass tissue/clots?
Do they think the abortion is complete?
Do they still feel pregnant?

AND ONE of the following options:

HSPT negative 5‒6 weeks after mife

By sonography

By decrease in HCG from initial serum level

Serum HCG decline 60% after 3 days, OR
Serum HCG decline 90% after 7 days