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Miscarriage is a common medical condition, approximately 20% of recognized pregnancies end in early pregnancy loss (EPL, also called miscarriage occurring in the first trimester), and 25% of women experience at least one miscarriage in their lifetime. Patients with miscarriage and miscarriage-related concerns present to U.S. emergency departments (EDs) daily, with an estimated 900,000 ED visits attributed to miscarriage annually, representing 3% of all ED visits for women of reproductive age.1,2 In some cases these patients are actually sent to the ED by their OBGYN physicians to rule out an ectopic pregnancy, and often patients present to us as they’re unable to access timely care for bleeding in pregnancy in an outpatient setting.
Despite how common the need for miscarriage related care is amongst our patients, emergency medicine residency educational curricula have not historically focused a great deal on the counseling of patients with miscarriage, nor teaching the full spectrum of miscarriage management options (expectant, medication, and procedural management with manual uterine aspiration). Medication management notably is one treatment option that emergency medicine providers can easily offer patients to help them treat their miscarriage, and should be offered more readily to appropriate patients.
In addition, there has been an increase in the closure of labor and delivery units (also commonly called maternity wards) across the country, increasing the likelihood that emergency physicians may be expected to provide more miscarriage care on their own without an in-house OBGYN consultant immediately available for an in-person consult or assistance.
The American College of Emergency Physicians recognizes the importance of preparing emergency physicians to deliver evidence-based care consistent with its policies. In support of this mission, the Miscarriage Management Toolkit is a series of educational and instructional resources compiled to guide both the practice and teaching of the full spectrum of management options for first trimester miscarriage, i.e. expectant, medication and procedural management. It also includes resources to help clinicians counsel patients on their options when experiencing miscarriage in the ED.
References
ACEP’s Policy Statements Related to Miscarriage Care
Treatment Options for Miscarriage
Medication Management of Miscarriage - Medication Management Protocols
Mifepristone for miscarriage care - How to get mifepristone on formulary at your hospital if it's not yet available
Manual Uterine Aspiration (MUA) Management of Miscarriage
Analgesia for MUA
Train Emergency Physicians in MUA for Miscarriage - MUA Training Protocol for EM physicians
Educational Videos
Resources for Counseling Patients on Miscarriage Treatment Options
Patient Resources (Handouts) on Miscarriage
Training Nurses and Support Staff in MUA
Administrative and Billing Resources
