URGENT, EMERGENT, OR JUST MISSED? GEOPOLITICAL VARIATIONS IN THE MANAGEMENT OF EARLY PREGNANCY LOSS IN US EMERGENCY DEPARTMENTS

Objectives

We aimed to describe geopolitical variations in Emergency Medicine (EM) providers’ treatment of early pregnancy loss (EPL) and evaluated their attitudes toward directly managing EPL, with attention to the influence of post-Dobbs v Jackson Women’s Health Organization restrictions.

Methods

We distributed a nationwide anonymous survey to emergency medicine clinicians using specialty-specific listservs and social media platforms, exploring experience and comfort with EPL diagnosis and management, as well as relevant institutional and structural barriers, inclusive of state abortion restrictions. We examined associations between state restrictions and emergency medicine resources via bivariate analysis.

Results

Most participants (n=203) identified as female (56.6%), non-Hispanic White (69.0%), attendings (73.6%), in urban settings (82.7%) and abortion-permissive states (60.8%). Most reported comfort diagnosing (93.0%) and counseling (86%) about EPL. However, only 39.7% consistently counseled on all management options--expectant, medication, procedural. Participants in abortion-permissive states were significantly more likely to consistently offer comprehensive counseling (44.2% vs. 32.7%, p=0.02) and reported increased access to on-site Ob-Gyn consultation (49.6% vs. 27.5%, p=0.002). Regardless of restrictions, only 16.2% consistently prescribed mifepristone-misoprostol; fewer (3.5%) performed manual uterine aspiration. 49.7% felt stable patients experiencing EPL should not receive treatment in the ED; 48.7% felt Ob-Gyns should manage EPL; 44.0% reported that arranging follow-up was a barrier to management. The majority (78.1%) endorsed the importance of more training on medication management of EPL.

Conclusions

Less than 20% of emergency medicine clinicians consistently offer EPL treatment. On-site Ob-Gyn consultations remain an essential resource, though less accessible in abortion-restrictive states. Training emergency medicine providers to treat EPL and improving access to follow-up could improve care.