Miscarriage is often an emotionally charged event in a woman’s life. A woman diagnosed with early pregnancy loss or incomplete miscarriage has several treatment options, all proven safe and effective. She can choose expectant care, medication management with misoprostol, or uterine aspiration. A shared decision-making approach is useful for preference-sensitive decisions, like miscarriage management. Patient-centered counseling allows women to decide on the treatment option that best suits them.
After the diagnosis has been established, begin by discussing the following relevant information:
- Her diagnosis
- Details and success rates of each management method
- Any pertinent medical conditions that may affect her management
Next elicit from the patient her priorities for management:
- Does she prefer a more natural experience by passing the pregnancy at home? Does she desire a rapid resolution?
- What are her feelings about pain, bleeding, seeing pregnancy tissue, or having anesthesia during a procedure?
- Are family and work responsibilities, or experiences with prior miscarriages or abortions important factors?
Using a checklist of common priorities may be a useful decision aid for this discussion. As the clinician, your role is to translate how those priorities relate to each of the available management options.
After exchanging information regarding both the medical facts and her personal priorities, together you and the patient can reach a decision for how to manage her miscarriage. This decision should reflect her priorities and preferences. A woman who chooses expectant management may want to have misoprostol on hand, so that she can shift her approach later without having to return to the office. It is always important to provide a point of contact and definitive follow-up for women during the miscarriage process, and be able to make referrals for supportive counseling when needed.
Patient Treatment Priorities for Miscarriage (Counseling Decision Tool).
Video-based Modules — Counseling for EPL Management Options.
Video Lecture — Managing Early Pregnancy Loss: A Preference-Sensitive Decision.
Miscarriage Treatment Options — Patient education handout
Patient Aftercare Instructions for all treatment options
Miscarriage Counseling Resources
Wallace RR, Goodman S, Freedman LR, Dalton VK, Harris LH. Counseling women with early pregnancy failure: utilizing evidence, preserving preference. Patient Educ Couns. 2010 Dec;81(3):454-61.
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Insights into abortion and miscarriage care is a publication of the Reproductive Health Access Project and Innovating Education in Reproductive Health, a project of the Bixby Center for Global Reproductive Health, UCSF.
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