| Expectant Management |
- Non-invasive; body expels non-viable pregnancy
- Perceived as natural by patients
- Avoids anesthesia and surgery risks if successful
|
- Process is unpredictable; can last days to weeks
- Can have prolonged or heavy bleeding and cramping
- Despite waiting, may still require uterine aspiration or other intervention
|
Incomplete EPL:
- Day 7: 50%
- Day 14: 70-85%
- Day 46: 90%
Other types of EPL:
- Day 7: 23-30%
- Day 14: 35-60%
- Day 46: 65-75%
(Nanda 2012, Casikar 2010, Luise 2002) |
Medical Management
(With misoprostol) |
- Non-invasive
- Safe
- Highly effective
- Avoids medication, anesthesia and surgery risks if successful
- Highly cost-effective
|
- May cause heavier or stronger cramping than aspiration
- May cause short-term gastrointestinal & other side effects
- May still need uterine aspiration
|
Incomplete EPL:
Other types of EPL:
- Single Dose 71%
- Second Dose 84%
- Higher efficacy when no embryro/fetus or cardiac motion detected on US
(Ngoc 2013, Neilson 2013, Zhang 2005) |
| Office-based Aspiration |
- Predictable
- Offers fastest resolution
- Less bleeding than expectant or medication
- Low probability of further treatment need (<5%)
- Pain control with local plus oral or IV meds
- Compared to OR:
- Cost & resource savings
- Improved patient access,
- Continuity and privacy
- Less patient & staff time
|
- Rare risks of invasive procedure
- Less pain control options in some settings compared to an in-hospital procedure
|
(Nanda 2012) |
| Operating Room Aspiration |
Can be asleep
Predictable
Less time / bleeding than expectant or medication
Low probably of further treatment need (<5%) |
More cost, time, exams than office-based procedures
Risks associated with invasive procedure; general anesthesia
May be more bleeding complications with general anesthesia vs. office procedure |
(Nanda 2012) |