Medication Management of Early Pregnancy Loss in an Urban Texas Emergency Department

Among patients with early pregnancy loss (EPL) without medication complications or need for urgent surgical evacuation, treatment should largely be guided by patient preference. However, evidence describing medication management for EPL in the emergency department (ED) setting is limited. We examine the occurrence of medication management of EPL with misoprostol in an urban Texas ED, describe associated clinical outcomes, and identify patient and clinical factors associated with offering this treatment.

This was a retrospective study of patients with confirmed EPL at a single urban academic ED in Texas from November 1, 2022, to May 31, 2024. Data were collected via relevant EHR review. Eligible patients were identified via ICD-10 codes and reviewed using a structured abstraction tool. We identified patients who received expectant or medication management with misoprostol and reported clinical outcomes using descriptive statistics. An exploratory multivariable logistic regression was used to identify characteristics predictive of patients being offered misoprostol.

During the study period, 181 patients met our inclusion criteria. Most patients (n = 154; 85.1%) received expectant management. Misoprostol was offered to 44 patients (24%); 27 patients (15.0%) received the medication, all of whom had an OB consult. Seven-day return ED visits were low in both the expectant (n = 18; 11.5%) and medication (n = 2; 7.4%) management groups. Of the 18 patients managed expectantly with a 7-day return ED visit, six received misoprostol during the second visit. OB consultation strongly predicted patients being offered misoprostol (aOR 15.1; 95% CI 4.8-47.61).

Medication management was rarely provided to ED patients with confirmed EPL; OB was consulted for all patients who received misoprostol. Return ED visits were rare among patients managed expectantly and with misoprostol. Several patients received misoprostol during a return ED visit, which may suggest a missed opportunity for medication treatment of EPL during initial ED presentation.