Considering Abortion? 4 Essential Tests to Have Done First
As with any medical procedure, there are a few precautionary steps necessary for protecting your health and safety before undergoing an abortion procedure. How you prepare for an abortion can have a big impact on your long-term health and fertility. This blog will explore the importance of testing for your Rh factor, confirming your pregnancy through an ultrasound, and testing for STIs and potential anemia. Without the information that these tests provide, an abortion can put your short and long- term health at risk.
All medical procedures come with risks. Prior to a surgical or medication abortion, you can help protect yourself by getting your blood work done, getting a pregnancy confirmation ultrasound and testing for STIs.
Let’s explore the details:
1. Rh Factor
An abortion without treatment for your Rh factor could harm future pregnancies.
Have you ever wondered what “positive” or “negative” means when describing a blood type, such as O positive or AB negative? This term refers to your Rh Factor–a protein found on red blood cells. People with a “positive” blood type have this protein, whereas people with “negative” blood types do not (ACOG).
It’s very important to know your blood type if you become pregnant. When a woman is Rh-negative and her fetus is Rh-positive, it is called Rh incompatibility. This only becomes an issue if the maternal and fetal blood mix together. Usually during pregnancy, the blood of the woman and fetus do not mix. However, sometimes blood mixing can occur during labor, birth, miscarriage, ectopic pregnancy, and abortion (ACOG).
When the blood of an Rh-negative woman mixes with the blood of an Rh-positive fetus, the woman’s body recognizes that the Rh-positive blood is not hers, and makes antibodies to try and destroy this foreign blood type. This antibody formation is known as Rh Sensitization.* Then later when a future pregnancy occurs, if the fetus is Rh-positive, the woman’s antibodies can cross the placenta and attack this new fetus’s blood cells. Without enough red blood cells, there is not enough oxygen flow in the fetus’s body. This can lead to serious complications such as fetal anemia, liver failure, heart failure, and even stillbirth (Cleveland Clinic) (ACOG).
So, if you are Rh-negative and considering an abortion, how can you prevent problems with future pregnancies? Proper treatment to prevent Rh sensitization for women with negative blood types involves administering an injection of Rh Immunoglobulin (commonly referred to as RhoGAM®) before antibodies are formed. This medication is given in order to prevent the Rh-negative woman from creating any Rh antibodies in the first place, should blood mixing occur. RhoGAM® is currently the standard of care for Rh-negative pregnant women, with injections given around 28 weeks gestation, as well as after the birth (ACOG). RhoGAM® is also a standard treatment for women undergoing a surgical abortion. For those seeking a medication abortion, the FDA advises taking the same preventative measures regarding Rh Sensitization as a surgical abortion–receiving RhoGAM® during the abortion procedure (FDA). Then, even if there is blood mixing, the treatment should help to prevent antibodies from being formed. This is crucial for protecting future pregnancies, should that be a desire down the road.
“Ignoring these recommendations may have significant consequences for future pregnancies since 14% of untreated alloimmunized infants will be stillborn, and half will suffer neonatal death or brain injury.” (Zipurski)
It is estimated that 85% percent of people in North America are Rh-positive, so if you’re one of the 15% that are Rh-negative, it is very likely that your fetus will be Rh positive, creating the scenario of Rh incompatibility (Cleveland Clinic). Having your blood work done before an abortion is an essential step to knowing your blood type, and knowing whether it would be safest to receive RhoGAM® treatment to protect future pregnancies.
*Note: It is important to understand that Rh sensitization is not a concern for women who are Rh-positive.
2. Confirmation Ultrasound
An ultrasound can confirm whether you’re even carrying a viable pregnancy.
A pregnancy test by itself cannot medically confirm a pregnancy. In fact, there’s a lot of information that’s critical to know before an abortion that can only be obtained from a pregnancy confirmation ultrasound. Thrive Medical Clinic provides confirmation ultrasounds at no cost with no insurance needed.
1. Check for ectopic pregnancy:
Normally a pregnancy will implant within the uterus. However, with an ectopic pregnancy, implantation occurs outside the uterus, most commonly in the fallopian tubes. As the pregnancy grows here, it will eventually cause the tube to rupture, which causes internal bleeding and presents a life-threatening situation for the mother, requiring immediate surgery. Ectopic pregnancies are not viable, cannot move on their own, and always require treatment –either surgery or medication (ACOG). (Note: The pills used for a medication abortion are NOT an effective treatment for ectopic pregnancy.)
The tricky thing is that an ectopic pregnancy seems like a normal pregnancy at first; you may have early pregnancy symptoms such as tender breasts, nausea, a missed period, and even a positive result on a pregnancy test (ACOG) (Mayo). It’s important for your safety to know the location of your pregnancy early on. The best way to do this is through an early pregnancy confirmation ultrasound so that the precise location of the pregnancy can be visualized by a trained sonographer.
2. Know how far along the pregnancy is:
After receiving a positive result on your pregnancy test, your mind may begin racing, trying to track when conception happened, when your last period was, and how far along you might be. Despite efforts to track menstruation / conception, many women are not able to accurately track their gestational age with this information alone. This is often due to irregular menstrual cycles, confusion with implantation bleeding, and other factors.
A confirmation ultrasound in the first trimester is the most accurate method of determining how far along a pregnancy is (Morgan). The current upper limit for medication abortion set by the FDA is 10 weeks. Additionally, each state has different laws regarding abortion availability at different gestational ages. Knowing your gestational age will impact which types of abortion procedures you are eligible for, and may also impact each unique woman’s feelings about whether an abortion or another pregnancy option is preferred at that point.
3. Whether the pregnancy is viable:
A viable pregnancy is one that is located in the uterus*, with a developing fetus and cardiac activity (ACOG). When considering abortion, it’s important to know for sure that your pregnancy is viable, because if it’s not, then an abortion is an unnecessary procedure. Roughly 1 out of 10 pregnancies will end in miscarriage (ACOG). A non-viable pregnancy in the uterus will eventually be expelled on its own or may require treatment to complete the process.
There are many forms of miscarriage that may not present with obvious symptoms. For example, it is possible to have early pregnancy symptoms and a positive pregnancy test even though no embryo has developed–a form of miscarriage known as a blighted ovum (APA). It is also possible for a fetus to develop, but naturally pass on its own (ACOG). Occasionally this occurs without any early symptoms, known as silent miscarriage. Viability can be confirmed through an ultrasound, and should be one of your first steps in making plans for your pregnancy.
*Note: If a pregnancy is not viable due to an ectopic pregnancy (see above), medical attention beyond the scope of an abortion is necessary to manage the pregnancy and protect your safety.
4. Find out if you’re carrying twins:
A “multiple pregnancy” means there is more than one fetus (twins, triplets, and so on). Many women care about this possibility and may make a different decision for their pregnancy if they were to be carrying twins. This is yet another piece of information that cannot be obtained from a pregnancy test, and requires visualization from an ultrasound.
This information gathered through an ultrasound is essential in safeguarding your health as you consider your options or plan an abortion.
3. STI Testing
STI testing before an abortion helps prevent Pelvic Inflammatory Disease and infertility.
You’ve probably been told at some point that if you’re sexually active, it’s good to be tested regularly for sexually transmitted infections (STIs). This is because STIs can cause long-term damage to your health, such as Pelvic Inflammatory Disease.
Pelvic Inflammatory Disease (PID) is an infection of a woman’s reproductive organs (CDC). PID is most commonly caused by STIs like Chlamydia and Gonorrhea, although it can also occur from microbes associated with Bacterial Vaginosis (Pike) & (Mayo) & (Bridwell). These microbes typically start off in the lower genital tract (vagina and cervix). However, over time they can migrate to the upper genital tract (uterus, fallopian tubes, and ovaries) and cause permanent damage such as: long-term pelvic / abdominal pain, and scar tissue that blocks the fallopian tubes, which may lead to future ectopic pregnancies and/or infertility (CDC). These complications make PID a major concern for women’s health.
These microbes may also migrate upwards any time there is access to the upper genital tract, such as during a medical or surgical abortion (Pike). This means that for anyone considering an abortion, it’s very important to be tested beforehand for the presence of any infections that may cause PID.
You’d think you’d know if you had one of these infections, right? Well, it turns out that the pathogens that lead to PID often have no symptoms, meaning that many women can experience damage to their reproductive system without even knowing it (CDC). The good news is that damage can easily be prevented, because the treatment for these STIs is usually an antibiotic; however this treatment will not undo any damage that has already occurred from PID (CDC).
For anyone considering abortion, make sure to inquire about routine tests done before the procedure, such as STI testing, as well as the available treatment options.
4. Anemia
Find out if you’re anemic, and mitigate the effects of blood loss during a medication abortion.
Anemia occurs when the body doesn’t have enough hemoglobin or red blood cells to carry oxygen. Anemia has many causes, and can become more severe after blood loss. For example, consistently having heavy periods can create a risk for anemia (Mayo).
How does this impact a medication abortion? The FDA states that uterine bleeding occurs for almost all women who undergo a medication abortion, and that most can expect to bleed more heavily than they would during a typical period (FDA). This is because the second abortion pill, Misoprostol, causes the uterus to contract, which results in symptoms such as cramping and bleeding. How much blood a woman loses, and her hemoglobin levels before the abortion, have an impact on her health after the abortion. The amount of blood lost is also correlated to how far along the pregnancy is; as gestational age increases, blood flow to the uterus naturally increases to support the growing pregnancy. Therefore, the FDA warns that when women are farther along in their pregnancies, they will experience a longer duration of bleeding after a medication abortion.
Healthy adult women average hemoglobin levels of 12-16 g/dL, but studies on abortion safety have excluded patients with hemoglobin levels less than 10 g/dL, meaning that the safety of medication abortion for patients with anemia is unknown (ACOG). For those who experience excessive uterine bleeding during an abortion, treatment may involve uterotonics, vasoconstrictor drugs, surgical abortion, saline infusions, or blood transfusions. Because of these considerations, the FDA cautions that “special care” should be given to patients with severe anemia before a medication abortion.
Serious complications are most commonly associated with severe rather than mild anemia, and may include severe tiredness, heart problems, and death, if treatment is not given (Mayo). Due to the blood loss during an abortion, women diagnosed with severe anemia prior to an abortion could be at risk for life-threatening complications. The good news is that a simple blood test can tell you whether you have anemia, and how mild or severe it is. With this information, you can consult a health professional to know the proper precautions to take before undergoing a medication abortion.
What if I’m unsure about my abortion procedure?
All medical procedures come with risks and important safety considerations, and an abortion is no different. It is important to be well-informed so that you can protect your health and safety with whatever option you choose for your pregnancy.
Processing all of your pregnancy options can be overwhelming. If you’re not sure whether a medication abortion is the right choice for you, if you want to confirm your pregnancy, or if you just want a safe place to talk about your pregnancy options, we can help. Contact Thrive Medical Clinic at (231) 929-3488 or click here to make an appointment. All appointments are confidential and already paid for by members of the community, with no insurance needed.
“Awesome staff, super sweet and very educated! Gave lots of resources! The ultrasound tech was very good at knowing every answer to our questions. Thank you so much <3” - Patient Review
Sources:
Rh Factor Sources:
Anemia Sources:
“Medication Abortion up to 70 Days of Gestation.” ACOG, 14 Aug. 2020, www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/10/medication-abortion-up-to-70-days-of-gestation.
STD Sources:
Ultrasound Sources:
“Ectopic Pregnancy.” ACOG, Apr. 2020, www.acog.org/womens-health/faqs/ectopic-pregnancy.