Medical abortion in the community: tests before and check of success

Laboratory tests

• ABO and RhD blood group (unless a blood group card exists: one determination is enough)
• Serum β-hCG (quantitative) (baseline value if follow-up will be by assay, or pregnancy of unknown location)if neededFollow-up planned by hCG measurement: it is judged on the fall relative to the initial measurement ^[2]. Pregnancy of unknown location on ultrasound, without symptoms or risk factors: abortion remains possible, with an hCG measurement before and after the dose ^[2].
• FBC (if anaemia suspected from history or examination)if needednon-French guidelineACOG (United States, 2020), RCOG (UK, 2022) and the German guideline (2022) do not screen for anaemia routinely but measure haemoglobin on clinical suspicion or according to the history; the medical abortion studies excluded women with haemoglobin below 9.5 to 10 g/dL ^[3,4,5]. HAS (2021) and the short CNGOF text (2016) do not address this test ^[2,6]; the mifepristone SmPC calls for caution in case of anaemia and makes the choice of method depend on its degree ^[7].

On self-collected vaginal sample

• Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR) (to be offered)

Depending on exposure (see the STI page)

• HIV serologyif neededThe preliminary consultation is an opportunity to offer STI screening according to current recommendations ^[6]: risk factors (multiple partners, recent partner, history of STI, etc.).
• Syphilis serologyif neededThe preliminary consultation is an opportunity to offer STI screening according to current recommendations ^[6]: risk factors (multiple partners, recent partner, history of STI, etc.).
• Hepatitis B serologyif neededThe preliminary consultation is an opportunity to offer STI screening according to current recommendations ^[6]: risk factors (multiple partners, recent partner, history of STI, etc.).
• Hepatitis C serology (to be offered according to risk factors)if neededThe preliminary consultation is an opportunity to offer STI screening according to current recommendations ^[6]: risk factors (multiple partners, recent partner, history of STI, etc.).
• Dating ultrasound (not a laboratory test): encouraged, quickly accessible, but not essential if the date of the last period is certain.
• Cervical smear or HPV screening test if the woman is not up to date.

Between day 14 and day 21 after taking mifepristone

• Serum quantitative β-hCG
• Or: semi-quantitative urine self-test suited to follow-up after termination of pregnancy, with telephone follow-up; or pelvic ultrasound (not a laboratory test).