• Open-ended questions and active listening are useful for counseling a patient with suspected pregnancy loss, to help them cope with inherent uncertainties, and to elicit their priorities and preferences for management.


  • EPL can be managed safely and effectively with expectant care, medications, or uterine aspiration.
  • Expectant management has an unpredictable time course, with more bleeding and need for further interventions than aspiration, but no increased risk for infection.
  • Medication management with misoprostol is safe, effective, and avoids some risks associated with uterine aspiration, but may take longer and have more side effects.
  • Office based uterine aspiration is safe, efficient, cost-effective and more convenient than hospital based procedures in most situations.
  • In areas where abortion access is limited, patients may present with bleeding who have attempted self-induction, although data on this are lacking (Grossman 2010).


  • Strong patient preferences for management are common, making a shared decision-making approach useful and patient-centered.
  • Our role as primary care providers is to give patients as many treatment options as possible, and to minimize loss of continuity and inconvenience accessing care.
  • EPL management can be a great first step to bringing other reproductive health services to the primary care setting, such as medication and aspiration abortion.


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