Early Pregnancy Loss
Publication Date: November 1, 2018
Last Updated: March 14, 2022
Recommendations
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)
574
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)
574
Ultrasonography, if available, is the preferred modality to verify the presence of a viable intrauterine gestation. (B)
574
Surgical intervention is not required in asymptomatic women with a thickened endometrial stripe after treatment for early pregnancy loss. (B)
574
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)
574
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)
574
The use of a single preoperative dose of doxycycline is recommended to prevent infection after surgical management of early pregnancy loss. (C)
574
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)
574
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)
574
Recommendation Grading
Overview
Title
Early Pregnancy Loss
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
November 1, 2018
Last Updated Month/Year
January 23, 2024
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Adolescent, Adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Physician, nurse midwife, nurse, nurse practitioner, physician assistant
Scope
Counseling, Management
Diseases/Conditions (MeSH)
D011247 - Pregnancy, D011248 - Pregnancy Complications
Keywords
pregnancy loss, early pregnancy, first trimester