British Society of Abortion Care Providers (BSACP)

@bsacp.org.uk

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BSACP represents UK clinicians working in abortion care, providing a supportive community to promote best practice. Our vision is that every pregnant person has access to safe, high-quality abortion care.

There are several, simple methods to obtain correct diagnostic ultrasound images to satisfy screening for CSP in the first trimester. The criteria that should be met are as follows: (a) partially full bladder facilitates evaluation of the lower uterine segment; (b) a sagittal 2-dimensional image of the whole uterus, showing the uterine fundus and cervix (external and internal cervical ora), should be obtained; (c) on the sagittal image, an imaginary line dividing the uterus in half between the fundus and the external cervical os should be drawn ( Figure 1 ). If the center of the gestational sac is above the line, it is most likely to be an intrauterine pregnancy. If it is below the line, the diagnosis is most likely CSP or, in very rare cases, a cervical pregnancy (in the latter, the lack of a history of CD will be evident). 32 A CSP can also be diagnosed when there is a gestational sac and/or early placenta within the post CD niche, with very thin (≤2 mm) or nonmeasurable myometrial thickness between the urinary bladder and the sac. 32 , 35 Importantly, ultrasound is most useful up to 6 to 7 weeks, as later in the first trimester the sac with the embryo will slowly populate the uterine cavity and may be misdiagnosed as an intrauterine pregnancy. The earlier in the first trimester that ultrasound is performed, the more reliable is the diagnosis.

From NICE Website - we have reviewed the evidence and are updating recommendations on anti-D prophylaxis for women having a medical or surgical abortion.