Bloodwork for Medical Termination of Pregnancy
For medical termination of pregnancy, the essential bloodwork includes blood type and Rh status, with hemoglobin/hematocrit being the only other routinely recommended test; routine coagulation studies are not indicated in healthy patients without bleeding history.
Essential Pre-Procedure Testing
Blood Type and Rh Status (Mandatory)
- All patients require blood type and Rh determination before medical termination 1
- Rh-negative patients must receive RhIg (50 μg for pregnancies ≤12 weeks) within 72 hours post-procedure, as fetal red blood cells express Rh antigens from 6 weeks gestation 1
- Failure to administer RhIg risks aloinmunization with severe consequences for future pregnancies 1
Hemoglobin/Hematocrit
- Baseline hemoglobin assessment is recommended to establish pre-procedure values, particularly important given that medical abortion has higher bleeding rates (28.3%) compared to surgical methods (9.1%) 1
- This allows for comparison if post-procedure anemia is suspected 2
- Median blood loss is approximately 74 mL (range 14-512 mL), with blood loss correlating significantly with gestational age 3
Tests NOT Routinely Required
Coagulation Studies (PT/INR, aPTT, Platelet Count)
- Routine coagulation testing is NOT indicated for healthy patients without bleeding history 4, 5
- Preoperative coagulation tests have no predictive value for postoperative bleeding in patients without synthetic liver dysfunction or anticoagulant use 4
- These tests should only be obtained if specific risk factors exist: known bleeding disorder, liver disease, anticoagulant use, or significant bleeding history 6
Complete Blood Count Beyond Hemoglobin
- Full CBC is not routinely necessary unless specific clinical concerns exist (e.g., suspected infection, thrombocytopenia history) 2
Clinical Context and Timing
When to Obtain Tests
- Blood type/Rh and hemoglobin should be drawn at the initial visit when medical termination is planned 1
- For patients with known coagulation abnormalities, repeat testing closer to procedure may be needed based on clinical stability 6
Post-Procedure Monitoring
- Follow-up visit at 7-14 days post-procedure is essential to confirm complete abortion and assess for complications 1
- Repeat hemoglobin only if clinical signs of significant anemia develop (excessive bleeding, fatigue, tachycardia) 1
- Complete abortion rates are approximately 95% for medical methods, with 17.4% requiring additional intervention for retained tissue 1, 2
Critical Pitfalls to Avoid
- Never skip Rh testing and RhIg administration in Rh-negative patients—this is the single most important preventable complication with long-term consequences 1
- Do not order routine coagulation panels in healthy patients—this wastes resources and has no predictive value 4, 5
- Do not rely solely on laboratory values; clinical assessment of bleeding patterns and vital signs is paramount 1
- Ensure same laboratory is used for any serial measurements to maintain consistency 7