Medication Abortion Checklist

DETERMINE ELIGIBILITY

  Confirm pregnancy 

  Rule out medical contraindications

  Determine gestational age≤ 84 days

  • LMP
  • Bimanual exam if indicated
  • Sonographyif 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

  • Mifepristonein office or out of office
  • Misoprostol (24‒48h after mifepristone if buccal use, 6‒72h ifvaginal 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 orprescribe:

  • Mifepristone 200mg for oral use
  • Misoprostol 800mcg for buccal or vaginal use
  • Document medication lot#/exp/NDC in chart
  • Asecond 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 q6–8hprn)
  • 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

Confirmationoptions:

  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 aftermife

  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
  •  

OFFER FOLLOW-UP

 Provide a way for the patient to contact the medical team, including after office hours
 Offer support for contraception, if desired

Download:

Share:

Evaluate: