Pregnancy of an unknown location (PUL) is a condition in which a pregnancy test is positive, but no intrauterine or extrauterine pregnancy is visualized using transvaginal ultrasonography. Most individuals with a PUL will eventually be diagnosed with an intrauterine pregnancy (IUP) with or without cardiac activity or an early pregnancy loss (EPL) with a location that was never visualized on ultrasonography. This Clinical Recommendation provides guidance for early abortion care, with a focus on managing an undesired PUL.

Patients seeking abortion care may have medical conditions that impact the counseling for and management of abortion care. This Clinical Recommendation provides recommendations regarding preabortion evaluation, abortion planning, and postabortion care in the setting of common chronic conditions. These conditions are defined broadly as conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both. 

Infection is a known yet rare (less than 1%) complication of abortion and early pregnancy loss (EPL). Postabortion infection is defined by the pathologic presence of bacteria in the upper genital tract after abortion or EPL. This Clinical Recommendation examines infection risk, identifiable risk factors, and prophylactic measures for the prevention of infection associated with procedural and medication abortion and early pregnancy loss (EPL) to make evidence-based recommendations for the clinical care of patients. 

Early pregnancy loss (EPL) makes up 15% of all clinically recognized pregnancies. Once diagnosed, a patient-centered approach should be used to counsel patients on their treatment options, including expectant management and active management by procedural management via uterine aspiration or medication management. This Clinical Recommendation provides evidence-based guidance on outpatient medication management of early pregnancy loss.  

There are over 18 million cancer survivors in the US, representing more than 5% of the population. With increasing trends in both cancer diagnosis and survivorship, patients impacted by cancer increasingly have unmet contraceptive needs. This Clinical Recommendation updates the Society’s 2012 guidance on contraception use for individuals with cancer and cancer survivors. It provides evidence-based recommendations to facilitate the management of and access to contraception care for individuals who are diagnosed with, being actively treated for, or who have previously been treated for cancer. 

Telemedicine utilization has increased significantly in recent years, with the potential to increase access to reproductive healthcare. These two Clinical Recommendations provide evidence-based guidance to optimize the management of and access to medication abortion and contraception care via telemedicine within the US.  

With several states imposing restrictions on abortion care and creating challenges to obtaining abortions earlier in pregnancy, the clinical need for abortions at or after 24 0/7 weeks of gestation is expected to increase. This Clinical Recommendation reviews relevant literature and summarizes the evidence for providing abortion care at or after 24 0/7 weeks of gestation in settings where it is legal to support the broadest, safest, and most patient-centered care.  

This Clinical Recommendation reviews clinical questions regarding complex management and special consideration in IUD care, from complexity assessment to placement through removal. This document will supplement already-existing guidance, such as the Centers for Disease Control and Prevention’s (CDC’s) forthcoming update to the US Medical Eligibility Criteria (US MEC) for Contraceptive Use and US Selected Practice Recommendations for Contraceptive Use (US SPR), and uplift patient-centered, trauma-informed, and complex care.  

This Clinical Recommendation provides evidence-informed, equitable, anti-racist, and person-centered recommendations to optimize the management of and access to medication abortion up to 13 6/7 weeks of gestation within a reproductive justice framework. It addresses eligibility, counseling, testing, medication regimens, and approaches such as no-test and advanced provision. It updates the Society’s current clinical guidance on medication abortion up to 70 days of gestation. 

This Committee Statement discusses interpreting and applying the Centers for Disease Control and Prevention’s forthcoming US Medical Eligibility Criteria for Contraceptive Use (US MEC) and US Selected Practice Recommendations for Contraceptive Use (US SPR) in clinical practice. It focuses on offering patient-centered counseling and care when a contraceptive method is classified as category 3 or 4 based on specific medical conditions or characteristics.  

This Clinical Recommendation will consider evidence-informed guidance for cervical preparation before abortion across gestational durations. This document will acknowledge that there is a range of safe, effective, and acceptable approaches to cervical preparation before abortion, and the selected approach may depend on patient response, the clinician’s technical capability, available resources, legal context, and institutional policies. To the extent possible, relevant documents will be timed to include findings from a forthcoming Cochrane review on first-trimester cervical preparation before abortion.  

This document is anticipated to serve as a revision to the Society’s current guidance on cervical preparation before abortion: (1) Cervical dilation before first-trimester surgical abortion (<14 weeks’ gestation), (2) Cervical preparation for second-trimester surgical abortion prior to 20 weeks’ gestation, and (3) Cervical preparation for dilation and evacuation at 20-24 weeks’ gestation. 

This Committee Statement will highlight the importance of offering pregnancy options counseling and timely access to abortion care, if desired, at the time of pregnancy diagnosis; at times when new information is identified about the pregnancy, such as changes in the health status of the pregnant person or fetus; and upon request by the pregnant person. This document will not include a list of serious medical conditions, life-limiting conditions, or specific personal considerations that would warrant offering pregnancy options counseling. This document will include information on patient-centered decision-making that centers the pregnant patient’s desires and outcomes as the standard of care, including the risks to the pregnant individual around remaining pregnant (eg, infection, cesarean delivery, medical conditions, mortality) and ethical concerns around forcing individuals to remain pregnant. 

This Committee Statement will review clinical questions related to complex management and special consideration for deeply placed and non-palpable contraceptive implants. It will focus on assessing the complexity of implant removal, localization, and removal of non-palpable contraceptive implants. Aligned with the Society’s vision, this document will be grounded in a patient-centered framework that prioritizes patient autonomy, builds trust and rapport, and individualizes contraception counseling and care.