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Open-ended questions and active listening are useful for counseling a patient with suspected early pregnancy loss (EPL).
Eliciting desired pregnancy outcome can help patients cope with inherent uncertainties, and to identify their priorities and preferences for management.
EPL can be managed safely and effectively with expectant care, medications, or uterine aspiration.
Expectant management has a more unpredictable time course, with more bleeding and need for further interventions than aspiration. There is no increased risk for infection.
EPL management with mifepristone and misoprostol is safe, effective, and avoids some procedural risks, but may take longer and may have medication side effects.
Office-based uterine aspiration is safe, efficient, cost-effective, and usually more convenient than hospital-based procedures.
Patients presenting with bleeding in early pregnancy may be experiencing early pregnacy loss or may have self-managed their abortion. Providers do not need to distinguish between the two – treatment strategies are the same for both situations (Raifman 2021).
Patients often have strong preferences for EPL management, and a shared decision-making approach is useful and patient-centered.
Our role is to give patients as many treatment options as possible, and to maximize continuity, safety, and access to care.
EPL management can be a great way to maintain continuity with a trusted provider for patients in the primary care setting. It can also be the first step to bringing other reproductive health services to the primary care setting, such as medication and aspiration abortion.