Written by Supraja Rachuri
Early pregnancy loss (EPL) occurs in 10% of clinically recognized pregnancies, making it an issue commonly encountered in reproductive health care. The American College of Obstetrics and Gynecology (ACOG) defines EPL as a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal cardiac activity within the first 12 6/7 weeks of gestation. Regardless of whether the pregnancy is planned or desired, it is hard to predict the social and psychological implications of pregnancy loss. To protect both the physical and mental health of patients who are facing this reality, we must provide them with the freedom to make educated decisions regarding their medical care. The recent, widespread restrictions on abortion in the US have made this fundamentally necessary care increasingly challenging to access.
Pregnancy loss can be managed in three different ways: expectant management, medical management, and surgical management. Expectant management requires minimal medical intervention, allowing the patient to pass the pregnancy on their own, whereas medical and surgical management of pregnancy loss requires the same interventions as an induced abortion. While abortion bans have severe implications on all aspects of reproductive health care, they have also been extremely damaging to people experiencing EPL. This is specifically due to the conservative guidelines in place that determine the viability of a pregnancy. For example, the current diagnostic criteria for EPL is based on recommendations from the 2012 Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy. These guidelines were created to reduce false EPL diagnoses, but they fail to recognize patients’ values and preferences when it comes to the diagnosis and management of EPL. ACOG recommends that additional clinical factors, including a person’s desire to continue the pregnancy, be considered when interpreting these ultrasound guidelines; however certain abortion bans may limit clinicians’ ability to do so if there is even a small possibility of a viable pregnancy. There are documented cases in which people who desired EPL management experienced delays in care due to such strict guidelines, placing them at increased risk of having an unwanted active miscarriage and subsequent severe bleeding, cramping, and psychological distress.
In light of the impacts abortion bans have had on patients experiencing EPL, it is critical for clinicians to educate themselves on available resources, their own legal context, and to focus on counseling patients thoroughly. Specifically, it is important to highlight to patients that they have the option to pursue medical management with medications like mifepristone and misoprostol, versus surgical management with procedures like manual vacuum aspiration or dilation and suction curettage. If patients are unable to access timely care for their EPL, websites like abortionfinder.org or ineedana.org can help patients find nearby clinics or provide patients with telehealth providers.
Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.