Early Pregnancy Loss

Publication Date: November 1, 2018
Last Updated: March 14, 2022


In patients for whom medical management of early pregnancy loss is indicated, initial treatment using 800 micrograms of vaginal misoprostol is recommended, with a repeat dose as needed. The addition of a dose of mifepristone (200 mg orally) 24 hours before misoprostol administration may significantly improve treatment efficacy and should be considered when mifepristone is available. (A)

The use of anticoagulants, aspirin, or both, has not been shown to reduce the risk of early pregnancy loss in women with thrombophilias except in women with antiphospholipid syndrome. (A)

Ultrasonography, if available, is the preferred modality to verify the presence of a viable intrauterine gestation. (B)

Surgical intervention is not required in asymptomatic women with a thickened endometrial stripe after treatment for early pregnancy loss. (B)

The routine use of sharp curettage along with suction curettage in the first trimester does not provide any additional benefit as long as the obstetrician– gynecologist or other gynecologic provider is confident that the uterus is empty. (B)

Accepted treatment options for early pregnancy loss include expectant management, medical treatment, or surgical evacuation. In women without medical complications or symptoms requiring urgent surgical evacuation, treatment plans can safely accommodate patient treatment preferences. (C)

The use of a single preoperative dose of doxycycline is recommended to prevent infection after surgical management of early pregnancy loss. (C)

Although the risk of alloimmunization is low, the consequences can be significant, and administration of Rh D immune globulin should be considered in cases of early pregnancy loss, especially those that are later in the first trimester. (C)

Because of the higher risk of alloimmunization, Rh D-negative women who have surgical management of early pregnancy loss should receive Rh D immune globulin prophylaxis. (C)

Recommendation Grading



Early Pregnancy Loss

Authoring Organization

Publication Month/Year

November 1, 2018

Last Updated Month/Year

January 23, 2024

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Physician, nurse midwife, nurse, nurse practitioner, physician assistant


Counseling, Management

Diseases/Conditions (MeSH)

D011247 - Pregnancy, D011248 - Pregnancy Complications


pregnancy loss, early pregnancy, first trimester