What gynecological examinations are typically performed before an abortion?

Before undergoing a surgical or medication-induced abortion, a comprehensive gynecologic evaluation is essential to ensure patient safety, confirm the diagnosis, and identify any contraindications or risk factors. Standard pre-abortion assessments typically include a detailed medical history—focusing on menstrual patterns, prior pregnancies, contraceptive use, allergies, chronic conditions (e.g., hypertension, diabetes, bleeding disorders), and current medications. A physical examination includes vital signs, abdominal assessment, and often a speculum and bimanual pelvic exam to evaluate uterine size, position, and adnexal anatomy.

Diagnostic testing routinely involves transvaginal ultrasound to confirm intrauterine pregnancy, assess gestational age, rule out ectopic pregnancy or molar gestation, and detect structural abnormalities such as fibroids or adenomyosis. Laboratory studies include blood type and Rh factor (with Rh immunoglobulin indicated for Rh-negative individuals), complete blood count (to screen for anemia or thrombocytopenia), and screening for sexually transmitted infections (STIs)—particularly chlamydia and gonorrhea—given their association with post-procedure pelvic inflammatory disease. In some cases—especially for patients with comorbidities or those undergoing procedural abortion under sedation—additional tests such as coagulation profile, HIV testing (with consent), or electrocardiogram may be considered based on clinical judgment.

Importantly, counseling is an integral component of the pre-abortion visit: it covers procedure options, risks and benefits, expected recovery, contraception initiation (including same-day LARC placement when appropriate), and emotional support resources. All evaluations must adhere to evidence-based guidelines from organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO), prioritizing patient autonomy, confidentiality, and equitable access to care.