8. EARLY PREGNANCY LOSS MANAGEMENT

^{Updated June 2022 by Chelsea Faso MD, Caitlin Weber, MD, MS and Mayra Hernandez Schulte, MD}

This chapter will assist you in learning skills to support your patients through a common and often emotionally and physically difficult experience – the spontaneous loss of an early pregnancy. Management of early pregnancy loss commonly occurs in the primary care setting. The management options of expectant, medication, or aspiration management are recognized as being safe and effective.

CHAPTER LEARNING OBJECTIVES

Following completion of this chapter, you should be able to:

• Evaluate, diagnose, and counsel patients presenting with signs or symptoms of early pregnancy loss
• Evaluate for ectopic vs. early pregnancy loss, including hCG changes
• Answer questions about short- and long-term implications of early pregnancy loss including emotional effects and implications for fertility
• Present expectant, medication and aspiration management options
• Provide appropriate follow-up, including contraceptive counseling

VIDEOS

READINGS / RESOURCES

• Websites:
  • Managing Early Pregnancy Loss (IERH)
  • Miscarriage Resources (RHAP)
  • Training, Education and Advocacy in Miscarriage Management (UW)
• Patient Resources:
  • Anita’s Miscarriage Zine (RHAP)
  • https://www.emptycradle.org
  • https://www.throughtheheart.org
• MacNaugton, H, Nothnagle, M, Early, J. Mifepristone and Misoprostol for Early Pregnancy Loss and Medication Abortion. Am Fam Physician 2021 Apr 15;103(8):473-480.
• Hendricks, E, MacNaughton, H, Mackenzie, M. First Trimester Bleeding: Evaluation and Management. Am Fam Physician. 2019 Feb 1;99(3):166-174.
• Prine LW, MacNaughton H. Office management of early pregnancy loss. Am Fam Physician. 2011 Jul 1;84(1):75-82.