Early Pregnancy Loss

Managing, Counseling, and Diagnosis

Research shows that people have strong and diverse preferences for how their miscarriage is managed. Patients report higher satisfaction when offered all management options and are treated according to their personal priorities and preferences.

If you would like to be able to assign this content to learners and track their progress, you can request a login for RHEcourse, our free online platform for SRH education, which offers additional features for users who want to engage more deeply. If you are a learner who would like to enroll in these courses for self-paced learning, you can request a RHEcourse login for self-paced learning.

IERH acknowledges the importance of inclusive language as a component of patient-centered care and we are working to improve our content. Read more here.

Clinical Updates

Early Pregnancy Loss – Evaluation and Diagnosis

Presented by Robin Wallace, MD, MAS
Planned Parenthood South Atlantic

Citations for this course are available on the course page.

Counseling and Decision-making for EPL Management

Presented by Robin Wallace, MD, MAS
Planned Parenthood South Atlantic

Citations for this course are available on the course page.

Overview of EPL Management Options

Presented by Robin Wallace, MD, MAS
Planned Parenthood South Atlantic

Citations for this course are available on the course page.

Early Pregnancy Loss – Medication Management

Presented by Robin Wallace, MD, MAS
Planned Parenthood South Atlantic

Citations for this course are available on the course page.

Early Pregnancy Loss – At-home Care Principles

Presented by Robin Wallace, MD, MAS
Planned Parenthood South Atlantic

Citations for this course are available on the course page.

Second Trimester Pregnancy Loss

Presented by Robin Wallace, MD, MAS
Planned Parenthood South Atlantic

Citations for this course are available on the course page.

Clinical Procedures & Counseling

Learning Objectives:

After watching these video lectures, learners will:

  • Review the similarities between management of early pregnancy loss (EPL) and early abortion
  • Describe patient-centered counseling for EPL

Video Modules

The following videos include didactic narratives, provider testimonials, and live video and animation demonstrating a step-by-step method for surgical early pregnancy loss management. Quizzes to test your knowledge are available for further exploration of these topics.

Practice Integration of EPL Management Services

Hear from real providers about how they integrated Early Pregnancy Loss services into their routine practice. Suggestions for implementation and evaluation of new services are presented.

 

EPL Management in Low Resource Settings

Low resource settings present unique challenges to the evaluation, diagnosis and management of EPL. Using Mulago Hospital in Uganda as one example, adaptations and alterations of clinical protocols are reviewed.

Additional Resources

Experiencing a miscarriage can be extremely difficult for many patients. This Counseling Decision Tool is intended to help the patient and provider choose a treatment that best fits the patient’s priorities and preferences.

Clinical Resources: This page includes tools that can serve as quick references to increase your confidence in providing evidence-based evaluation, diagnosis, and treatment of early pregnancy loss.

Practice Integration: Standardized protocols and education materials not only ensure consistency of the services provided but also reinforce the importance and safety of these management options with staff and patients who are unfamiliar with office-based early pregnancy loss management.

Patient Education Materials: Research shows that women have strong and diverse preferences for how their miscarriage is managed and report higher satisfaction when offered all options and treated with the method according to their personal priorities and preferences.

** You can also download free ibook versions of this video-based curriculum!

Part I. Clinician Guide for Managing Early Pregnancy Loss
– Includes the modules: Evaluation & Diagnosis, Counseling, Practice Integration, Low-Resource Settings

Part II. Clinician Guide for Managing Early Pregnancy Loss
– Includes the modules: Expectant Management, Medication Management, and Uterine Aspiration

PARTICIPANT SURVEY

Please complete this short survey after viewing the learning module. Your answers will help us better understand our learners and how to improve our curriculum for you.

Citations

American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 200: Early Pregnancy Loss. Obstet Gynecol. 2018;132(5):e197-e207. doi:10.1097/AOG.0000000000002899

American College of Obstetricians and Gynecologists. Improving access to mifepristone for reproductive health indications. Position Statement. Washington, DC: American College of Obstetricians and Gynecologists; 2018. (Level III)

Consensus Statement: Instructions for Us–Misoprostol for Treatment of Incomplete Abortion and Miscarriage. Expert Meeting on Misoprostol sponsored by Reproductive Health Technologies Project and Gynuity Health Projects. June 9, 2004. New York, NY.

Dzuba IG, Castillo PW, Bousiéguez M, Margarita Lugo Hernández E, Juan Castañeda Vivar J, Sanhueza Smith P. A repeat dose of misoprostol 800mcg following mifepristone for outpatient medical abortion at 64-70 and 71-77 days of gestation: A retrospective chart review [published online ahead of print, 2020 May 28]. Contraception. 2020;S0010-7824(20)30160-8.

Flink-Bochacki R, Hamm ME, Borrero S, Chen BA, Achilles SL, Chang JC. Family Planning and Counseling Desires of Women Who Have Experienced Miscarriage. Obstet Gynecol. 2018;131(4):625-631. doi:10.1097/AOG.0000000000002520

Flynn AN, Roe AH, Koelper N, McAllister A, Sammel MD, Schreiber CA. Timing and efficacy of mifepristone pretreatment for medical management of early pregnancy loss. Contraception. 2021;103(6):404-407. doi:10.1016/j.contraception.2021.01.007

Henkel A, Shaw KA. Advances in the management of early pregnancy loss. Curr Opin Obstet Gynecol. 2018;30(6):419-424. doi:10.1097/GCO.0000000000000501

Mark A, Foster AM, Grossman D, Prager SW, Reeves M, Velásquez CV, et al. Foregoing Rh testing and anti-D immunoglobulin for women presenting for early abortion: a recommendation from the National Abortion Federation’s Clinical Policies Committee. Contraception. 2019;99(5):265-66].

Nagendra D, Koelper N, Loza-Avalos SE, et al. Cost-effectiveness of Mifepristone Pretreatment for the Medical Management of Nonviable Early Pregnancy: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2020;3(3):e201594. doi:10.1001/jamanetworkopen.2020.1594

The Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril 2012;98:1103–11.

Roe AH, McAllister A, Sammel MD, Schreiber CA. Pregnancy intentions and contraceptive uptake after miscarriage. Contraception. 2020;101(6):427-431. doi:10.1016/j.contraception.2020.03.002

Schreiber CA, Creinin MD, Atrio J, Sonalkar S, Ratcliffe SJ, Barnhart KT. Mifepristone pretreatment for the medical management of early pregnancy loss. N Engl J Med 2018; 378:2161–70. (Level I)

Shorter JM, Atrio JM, Schreiber CA. Management of early pregnancy loss, with a focus on patient centered care. Semin Perinatol. 2019;43(2):84-94. doi:10.1053/j.semperi.2018.12.005

Wallace R, DiLaura A, Dehlendorf C. “ ‘Every person’s just different’: Women’s Experiences with Counseling for Early Pregnancy Loss Management.” Women’s Health Issues, 2017; 27-4: 456-462.

Wiebe E, Campbell M, Aiken A, Albert A. Can we safely stop testing for rh status and immunizing rh-negative women having early abortions? A comparison of Rh alloimmunization in Canada and the Netherlands. Contraception: X. 2019;100001;

Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. National Institute of Child Health Human Development (NICHD) Management of Early Pregnancy Failure Trial. N Engl J Med 2005;353:761–9.

 

Course Development

Early pregnancy loss is designed to teach clinical learners to recognize people have strong and diverse preferences for how their miscarriage is managed. Patients report higher satisfaction when offered all management options and are treated according to their personal priorities and preferences.  Thus, learners will consider how to provide patient-centered pregnancy loss care to meet the individual needs of patients regardless of provider preferences.

Led by Robin Wallace, MD, MPH (she/her)  Early Pregnancy Loss is a result of transdisciplinary research supported by The Bixby Center for Global Reproductive Health and curriculum development support from the staff of Innovating Education in Reproductive Health.

See the acknowledgments section below for all our critical partners and mentors in this work.

https://www.earlypregnancylossresources.org/about/