From the Guidelines
The American College of Obstetricians and Gynecologists (ACOG) recommends medical management with misoprostol as a safe and effective option for early pregnancy loss, with a success rate of 80-90% within 1 week. For medical management, misoprostol is typically administered as 800 mcg vaginally as a single dose or repeated in 24 hours if needed 1. Adding mifepristone 200 mg orally 24 hours before misoprostol can increase effectiveness to 95%.
Management Options
- Expectant management: patients wait for spontaneous passage of pregnancy tissue, which is successful in 80% of cases within 8 weeks but carries a risk of heavy bleeding.
- Medical management: involves misoprostol, with an 80-90% success rate within 1 week.
- Surgical management: through vacuum aspiration is nearly 100% effective and provides immediate completion but carries procedural risks.
Patient Counseling
- Expected symptoms: cramping, bleeding
- When to seek emergency care: soaking 2 pads per hour for 2 consecutive hours
- Pain management options
- Emotional support resources
Follow-up
- Should occur within 1-2 weeks to confirm complete expulsion
- Typically using serial hCG measurements or ultrasound
The choice between management options should be based on patient preference, clinical circumstances, gestational age, and medical history, as all approaches are considered safe and effective for most patients with early pregnancy loss 1.
From the Research
ACOG Early Pregnancy Loss Management
The American College of Obstetricians and Gynecologists (ACOG) provides guidelines for the management of early pregnancy loss. According to the Society of Family Planning Clinical Recommendation 2, the following options are recommended:
- Expectant management
- Medication management
- Procedural management When urgent treatment is not necessary, patients should have equal access to all treatment options.
Medication Management
Medication management for early pregnancy loss is a safe and effective option. The recommended regimen includes:
- Mifepristone 200 mg orally, followed by misoprostol 800 mcg vaginally or buccally 7-48 hours later 2, 3
- Misoprostol alone can be used in two or more doses of 600-800 mcg sublingually or vaginally at intervals of at least 3 hours 2
- Ibuprofen 800 mg orally can be used for pain control during medication management 2
Patient-Centered Care
Patient-centered care is essential in the management of early pregnancy loss. Shared decision-making and evidence-based counseling can improve patient satisfaction with care 4. Clinicians should offer all patients, but not require, in-person confirmation of completed early pregnancy loss 2.
Complications and Follow-Up
Complications of medication management for early pregnancy loss are rare, but can include:
- Ongoing pregnancy
- Infection
- Hemorrhage
- Undiagnosed ectopic pregnancy
- Need for unplanned uterine aspiration 3 Follow-up care should include clinical history, serial quantitative beta human chorionic gonadotropin levels, urine pregnancy testing, or ultrasonography to establish complete passage of the pregnancy tissue 3. Institutions and clinicians should make thorough efforts to obtain and maintain access to mifepristone in clinical settings where patients receive early pregnancy loss care 2.