Miscarriage Management Resources

Management options

Management Options Counseling

• How Much Am I Bleeding?

• EPL Management Options: Advantages, Disadvantages, and Efficacy

• Miscarriage Treatment Options - English (RHAP)

• Miscarriage Treatment Options - Spanish (RHAP)

• Video role-play: EPL Management Options Counseling (UW - 4 minutes)

• Video role-play: Counseling for EPL Management Options (UCSF - 17 minutes)

Uterine Aspiration

• Performing MVA using the Ipas

• MVA for Uterine Evacuation: Pain Management

• Managing Complications of MUA for Early Pregnancy Loss

• Provider Uterine Aspiration Script

• MUA Instrument Set-Up Image
  

Patient Information and Support

Patient Education

• Early Pregnancy Loss Patient Education Sheet (ARHP)

• Medication and Aspiration Management of EPL Patient Education Handouts

• Medication and Aspiration Management of EPL Patient Education Handouts (Spanish)

Patient Counseling

• Emotional Support Resources for Early Pregnancy Loss

• Counseling Practice Points for EPL

• Frequently Asked Questions by EPL Patients

• Video role-play: Counseling for EPL Management Options (UCSF)

Administrative Tools

Sample Protocols

• Emergency Department Sample Protocol

• Office MUA for EPL Sample Protocol

• Medication Management for EPL Sample Protocol (RHAP)

• Nursing Sample Protocol for Office Uterine Aspiration

Sample Consent Forms

• Medication Management Consent

• Uterine Aspiration Consent

Billing and Coding

• Coding for Miscarriage Management

Equipment

• HPSRX Enterprises (Manual Vacuum Aspirator products distributor)

• Uterine Aspiration Instrument Set-Up Image

Phone Triage

• Phone triage for miscarriage management (RHAP)
  

Teaching Tools

• Do Nothing, Do Something, Aspirate - Didactic Powerpoint Slides

• Opinions Exercise

• Paracervical Block Image

• Evaluation of basic ultrasound skills

• EPL Management Task List and Staff Competency Checklist

• Video role-play: Counseling for EPL Management Options (UCSF)

Important Publications

• ACOG Practice Bulletin: Early Pregnancy Loss - 2018 Interim Update

• Doubilet et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. 2013

• Schreiber et al. Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss. 2018

• Farren et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. 2020

• Shorter et al. Racial disparities in mental health outcomes among women with early pregnancy loss. 2021.

Miscarriage Management in the Clinic

• Darney et al. The Family Medicine Residency Training Initiative in Miscarriage Management: Impact on Practice in Washington State. 2013

• Darney et al. “We have to what?”: lessons learned about engaging support staff in an interprofessional intervention to implement MVA for management of spontaneous abortion. 2013

• Darney et al. “One of those areas that people avoid” a qualitative study of implementation in miscarriage management. 2013

• Godfrey et al. Early pregnancy loss needn't require a trip to the hospital. 2009

Miscarriage Management in the Emergency Department

• McCoy et al. Practice change following an interdepartmental training on early pregnancy loss management in the emergency department, 2022

• Benson et al. Early pregnancy loss in the emergency department, 2006-2016. 2021

• Quinley et al. Manual Uterine Aspiration: Adding to the Emergency Physician Stabilization Toolkit. 2017

• Kiniwarala et al. Manual vacuum aspiration in the emergency department for management of early pregnancy failure. 2012

• Wittels et al. United States emergency department visits for vaginal bleeding during early pregnancy, 1993-2003. 2008

• Dennis et al. Barriers to and Facilitators of Moving Miscarriage Management Out of the Operating Room. 2015

• Baird et al. Women's experiences with early pregnancy loss in the emergency room: A qualitative study. 2018

• Miller et al. Patient experiences with miscarriage management in the emergency and ambulatory settings. 2019

• Evans, C. Early Pregnancy Loss in the Emergency Department: Lessons Learned as a Spouse, New Father, and Emergency Medicine Resident. 2020.

Other digital resources

• TEAMM Emergency Medicine Trainer Kelly Quinley FIX19 Talk: A Call to Action for Improving Emergency Miscarriage Care (includes video)

• Innovating Education in Reproductive Health (includes video modules)

• Reproductive Health Access Project (RHAP)

• The Papaya Workshop online

COVID-19 RESOURCES FOR EARLY PREGNANCY LOSS

• Sample guideline for telephone follow-up for medication management of early pregnancy loss

• Sample telehealth EHR note: Follow-up for medication management of early pregnancy loss

• No-touch sample protocol for increasing access to care during a pandemic (written for management of induced abortion, though principles apply to management of early pregnancy loss)