Early Pregnancy Loss

Miscarriage is a common medical condition, and it forms part of our work in emergency medicine - approximately 20% of recognized pregnancies end in early pregnancy loss (EPL, also called miscarriage 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  Sometimes 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 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 aspiration/procedural management with manual uterine aspiration). Medication management specifically 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 (aka maternity wards) across the country, which means emergency physicians may be expected to provide more miscarriage care on their own.

The American College of Emergency Physicians has recognized the need for emergency physicians to be prepared to provide evidence-based care to our emergency patients as supported by our policies and resources.

References

1.  Benson, Lyndsey S., et al. “Early Pregnancy Loss in the Emergency Department, 2006-2016.” Journal of the American College of Emergency Physicians Open, vol. 2, no. 6, Dec. 2021, p. e12549, Learn More.
2. Wittels, Kathleen A., et al. “United States Emergency Department Visits for Vaginal Bleeding during Early Pregnancy, 1993-2003.” American Journal of Obstetrics and Gynecology, vol. 198, no. 5, May 2008, p. 523.e1-6, Learn More.

ACEP’s Policy Statements

Management Options for Miscarriage Management in the Emergency Department

Medication Management of EPL - Resources

How to get Mifepristone for EPL on formulary at your hospital if it’s not yet available

Procedural Management of EPL aka MUA - Resources