A new ACOG Practice Bulletin was published for management of early pregnancy loss recommending single dose misoprostol 800 mcg per vagina. As patients in the emergent setting are often stable with no need for urgent management they are typically offered expectant, medical, or surgical management. Many patients require time to process and grieve their loss. However, for those desiring medical management a research question was proposed evaluating if immediate initiation of single dose misoprostol for early pregnancy loss results in fewer follow up visits when compared to outpatient management.METHODS:
A retrospective chart review was performed evaluating patients seen by a provider in the Emergency Department diagnosed with early pregnancy loss at 9 weeks gestation or less, and received treatment with misoprostol from 1/1/11 to 3/1/15.RESULTS:
A two-sample proportion test analysis was performed showing no statistically significant results. Of the twenty-three patients seen by a provider and eligible for immediate initiation of single dose misoprostol regimen, eighteen opted for immediate management. Twelve of these patients had one follow up visit with single dose regimen success. Of the five patients evaluated who opted for delayed initiation of misoprostol, two patients had one follow up visit with single dose regimen success. Three patients required two additional follow up visits.CONCLUSION:
No statistically significant difference in the total number of clinic visits was noted. However given the small sample size of this population, a larger difference may be detected with a larger sample size.