SUMMARY POINTS
Skills
- Open-ended questions and active listening are essential for counseling someone with suspected or confirmed EPL.
- Eliciting desired pregnancy outcomes can help guide people coping with uncertainties to identify priorities and preferences for management. (Note: desired pregnancy outcomes do not always correlate with feelings related to EPL).
Safety
- EPL can be managed safely and effectively with expectant care, medications, or uterine aspiration (Ghosh 2021).
- Expectant EPL management has a more unpredictable time course, with more bleeding and need for interventions than aspiration, but no increased risk for infection (Ghosh 2021).
- EPL management with mifepristone and misoprostol or misoprostol alone is safe, effective, and usually avoids procedural risks, but comes with medication side effects. Adding mifepristone increases success rates (Schreiber 2018).
- Office-based uterine aspiration is safe, efficient, more cost-effective, and often more convenient than hospital-based procedures.
- Since treatment strategies are similar for those presenting with bleeding in early pregnancy regardless if due to EPL or abortion, clinicians should avoid medically irrelevant questions, or documenting suspected cause of EPL, that may put people at risk of criminalization (Raifman 2021; See Ch. 2: Preventing Criminalization).
Role
- Abortion bans have effects on both routine and emergent clinical care for miscarriage and early pregnancy complications (Nandi 2024).
- In the current legal climate, it is crucial to adhere to evidence-based guidelines for active EPL management to ensure patient safety.
- People often have strong preferences for EPL management, and shared decision-making is essential.
- The clinician’s role is to present all treatment options while maximizing continuity, access, safety, and autonomy.
- EPL management in the primary care setting can help people maintain continuity with a trusted clinician and can be the first step to expanding other reproductive health services, such as medication and procedural abortion. A number of programs are available to provide technical assistance for integrating these services (See Ch 10: Technical Assistance Programs).