This document is currently under revision.
Clinical guidance is rigorously developed to reflect the best available evidence at the time of publication. It is designed as a resource to assist clinicians in providing family planning care. It is not intended to substitute for the independent professional judgment of the treating clinician. We recognize that continued research, new understandings of person-centered care, or major changes in the legal landscape can impact clinical guidance. It should not be considered inclusive of all proper treatments or serve as the standard of care. Variations, taking into account individual circumstances, may be appropriate.

Most women undergoing first-trimester abortion are healthy. However, abortion providers also encounter women with a wide variety of medical conditions, some of which are serious and complex. When such a condition exists, consultation with the woman’s physician or a specialist can facilitate decision making regarding hospital referral and additional preparations that may be required. Medical conditions may determine the approach to abortion. Surgical abortion is preferred when mifepristone or methotrexate is contraindicated. Medication abortion may be preferred when lithotomy position is not possible or in patients with extreme obesity. Limited data suggest that women treated with anticoagulation therapy bleed more than other women during surgical abortion, although this additional bleeding may be clinically unimportant. The decision to temporarily discontinue anticoagulation therapy will depend on the agent used and the underlying risk of thrombosis. According to the American Heart Association, additional antibiotics are not recommended to prevent endocarditis in women with cardiac lesions during surgical abortion. We review specific recommendations for women with common medical conditions. In some women, highly effective post-abortion contraception is essential to prevent pregnancy-related morbidity. The U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, provides guidance for method selection for women with medical problems.