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.