Very early pregnancies (below 6 weeks gestation)

More and more women are diagnosing their pregnancy very early and also deciding to terminate it early, before an intrauterine pregnancy can be diagnosed by a health professional. Even at such an early stage, a surgical or medical abortion can be performed effectively and safely from a medical point of view. The procedure is easier and leads to fewer complications, the earlier it is performed.

What should be considered in an early pregnancy?

However, the following considerations should be kept in mind, and a follow-up should be performed after one week.

A pregnancy smaller than 6 weeks gestation is too small to be seen by ultrasound (1). Therefore, it is not possible to diagnose the location: i.e., whether nidation took place within the uterine cavity (as is the case for almost all pregnancies) or outside the uterus (ectopic), for example in the tubes (very rarely).

While an ectopic pregnancy is a rare event, it is important to diagnose it because:
-    It is a potentially dangerous situation for the woman and needs to be diagnosed and treated without delay.
-    It requires a special operation (laparoscopy) or treatment (methotrexate) and cannot be terminated either by surgical or medical abortion.

The typical symptom of an ectopic pregnancy is increasing and constant pain in the lower right or left abdomen. If you experience such pain, you should see a doctor immediately.

Your doctor will determine the level of the pregnancy hormone hCG in your blood to diagnose a very early pregnancy that cannot yet be seen by ultrasound. A week later this should be repeated. The second hCG test can also be done by the woman herself using a specific urinary pregnancy test (low sensitivity type).

A follow-up after one week is a necessary precautionary measure in all women with a very early pregnancy, regardless of whether they have an abortion or decide to continue the pregnancy.

A significant decrease in the hCG level after one week indicates a successful abortion. Further follow-up visits are not necessary, unless there are other complications like heavy bleeding, pain, etc.

An increased or stable hCG level at follow-up is a possible indicator of an ectopic pregnancy. In this case, an ultrasound should be done as soon as possible to diagnose the location of the pregnancy. Depending on the result, further examinations or treatment will be decided upon.

Abortion of a very early pregnancy is a highly effective and safe procedure if this protocol is respected.

(1) No gestational sac is visible or the gestational sac is so small that a reliable diagnosis is not possible.