Early Pregnancy Loss

Early pregnancy loss during the first trimester is commonly known as miscarriage or spontaneous abortion.143 

Given how common early pregnancy loss is and that many people are unable to establish prenatal care until after the first trimester, providers of SRH care should be able to identify signs and symptoms of early pregnancy loss and be equipped to provide appropriate treatment or referrals. All pregnant persons should receive information about the signs and symptoms of early pregnancy loss and given instructions to report any concerns to a provider for further evaluation.

Providers can confirm early pregnancy loss by reviewing a patient’s medical history; identifying the signs and symptoms, including vaginal spotting or bleeding with or without pain, and bleeding and/or passage of tissue from the vagina; and/or by conducting a physical exam that may include a pelvic ultrasound and quantitative β-hCG testing, depending on the resources available on-site.

Pregnancy loss can be managed in several ways: (1) expectantly, (2) with medications, and (3) uterine aspiration. Patient preference is paramount in determining the course of action. Expectant management is essentially “wait and watch” to assess whether the pregnancy resolves itself with no medical interventions. Decision aid tools have been shown to improve knowledge of treatment options and can be helpful to both providers and patients.144

Providers should also be prepared to identify and provide treatment or referral in the event of a suspected ectopic pregnancy. An ectopic pregnancy, or pregnancy occurring outside of the uterus, requires immediate medical care. Ectopic pregnancy occurs in about two out of every 100 pregnancies.145 Providers should be aware of the signs of ectopic pregnancy: (1) abnormal vaginal bleeding, (2) low back pain, (3) mild pain in the abdomen or pelvis, and (4) mild cramping on one side of the pelvis.146 Ectopic pregnancy can be dangerous if not treated and can cause internal bleeding, infection—and, in some cases, death—to the pregnant person.

Persons experiencing pregnancy loss may benefit from additional social support. The provider can assess the patient’s need and desire for social support and refer them to appropriate counseling or supportive services. For additional information about management of early pregnancy loss, please refer to ACOG.143