8. EARLY PREGNANCY LOSS MANAGEMENT
Updated 2025 by Innes Tounkel MD, Caitlin Weber MD, MS and Jasmine Stewart MD, MS
This chapter will review skills to support people through a common and often emotionally and physically difficult experience – the spontaneous loss of an early pregnancy. Early pregnancy loss (EPL) is common and can be managed in the primary care setting. The options of expectant, medication, and procedural management are safe and effective.
Chapter Learning Objectives
Following completion of this chapter, you should be able to:
- Evaluate, diagnose, and counsel people 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 future fertility
- Present expectant, medication and aspiration management options
- Provide appropriate follow-up, including contraceptive counseling
Videos
Readings / Resources
- Websites:
- Early Pregnancy Loss Modules and Presentations (IERH)
- Miscarriage Resources (RHAP)
- Clinical Recommendation: Medication Management for EPL (SFP)
- Training, Education and Advocacy in Miscarriage Management (UW)
- Early Pregnancy Loss (NLM Stat Pearls)
- Mifepristone and Misoprostol for Early Pregnancy Loss and Medication Abortion (MacNaughton 2021)
- First Trimester Bleeding: Evaluation and Management (AAFP)
- ACOG Practice Bulletin No. 200: Early Pregnancy Loss
- Patient Resources: