Troublesome bleeding following early medical abortion

### Key messages Early medical abortion (EMA) (ie, using combination mifepristone and misoprostol to terminate pregnancies of less than 10 weeks’ gestation) is the the most common method of induced abortion in the UK.1 The majority of EMAs in the UK are completed by patients in their own homes. Success of abortion can be confirmed with self-performed low-sensitivity urinary pregnancy tests (LSUPTs). LSUPTs are used 2–3 weeks after misoprostol administration, depending on local protocol. LSUPTs turn positive at concentrations over 1000 iU human chorionic gonadotrophin (hCG).2 In response to the 2020 novel coronavirus (COVID-19) outbreak, UK guidance was issued to encourage telemedicine where possible (figure 1), and minimise the use of ultrasound3 scanning, in keeping with existing Royal College of Obstetricians and Gynaecologists (RCOG) guidance.4 Telemedicine for abortion care is also encouraged by National Institute for Health and Care Excellence (NICE) guidance and is likely to remain the standard of care beyond COVID-19.5 Figure 1 Patient journey through telemedicine early medical abortion (CCBY4.0 John Reynolds-Wright available from https://flic.kr/p/2j8HtKK). Ms X calls her general practitioner for advice – she has been experiencing light continual bleeding without pain for the last 4 weeks. Four weeks ago she had an EMA at home …