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Chapter 11 - The Role of Early Pregnancy Loss Care in Ensuring Competence in Uterine Evacuation

from Section II - Integration of Abortion into Graduate Medical Education

Published online by Cambridge University Press:  30 July 2021

By
Sarah Ward Prager  and
Erin McCoy
Edited by
Uta Landy ,
Philip D Darney  and
Jody Steinauer
Uta Landy
Affiliation:
University of California, San Francisco
Philip D Darney
Affiliation:
University of California, San Francisco
Jody Steinauer
Affiliation:
University of California, San Francisco
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Summary

Abortion. The phrase “uterine evacuation” can create tension and line people up on opposite sides of the abortion issue, with no recognition of its safety, commonplace occurrence and health or life-saving capabilities. Due to the dichotomized and politicized nature of abortion, in some places it is difficult to teach health care providers how to empty a uterus, even in a life-threatening situation.Early pregnancy loss (EPL) management can provide an entry point for this education, as well as a way to destigmatize the uterine aspiration procedure and medical treatment because, although management is the same as for “elective abortion” the indication is different; with an abortion, a pregnancy is terminated that would otherwise likely continue, while with EPL, the pregnancy has ceased to be viable. This difference is subtle, yet concrete and profound for many.

Keywords

Early pregancy lossspontaneous abortionmiscarriageuterine aspirationmisoprostolmifepristoneemergency.
Type
Chapter
Information
Advancing Women's Health Through Medical Education
A Systems Approach in Family Planning and Abortion
 , pp. 123 - 129
Publisher: Cambridge University Press
Print publication year: 2021

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References

ACOG Practice Bulletin No. 200 summary: early pregnancy loss. ObstetGynecol. 2018;132(5):1311–1313.Google Scholar
Wilcox, AJ, Weinberg, CR, O’Connor, JF, et al. Incidence of early loss of pregnancy. N Engl J Med. 1988;319(4):189–194.Google Scholar
Wang, X, Chen, C, Wang, L, Chen, D, Guang, W, French, J. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril. 2003;79(3):577–584.CrossRefGoogle ScholarPubMed
Zinaman, MJ, Clegg, ED, Brown, CC, O’Connor, J, Selevan, SG. Estimates of human fertility and pregnancy loss. Fertil Steril. 1996;65(3):503–509.CrossRefGoogle ScholarPubMed
Jones, RK, Jerman, J. Abortion Incidence and service availability in the United States, 2014. Perspect Sex Reprod Health. 2017;49(1):17–27.CrossRefGoogle Scholar
Curtin, S, Abma, J, Ventura, S, Henshaw, S. Pregnancy rates for U.S. women continue to drop. NCHS Data Brief. 2013;(136):1–8.Google Scholar
Harris, LH, Dalton, VK, Johnson, TRB. Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care. Am J Obstet Gynecol. 2007;196(5):445.e1–5.CrossRefGoogle ScholarPubMed
Dalton, VK, Harris, LH, Gold, KJ, et al. Provider knowledge, attitudes, and treatment preferences for early pregnancy failure. Am J Obstet Gynecol. 2010;202(6):531.e1–8.CrossRefGoogle ScholarPubMed
Nanda, K, Peloggia, A, Grimes, D, Lopez, L, Nanda, G. Expectant care versus surgical treatment for miscarriage. Cochrane Database Syst Rev. 2006;(2):CD003518.CrossRefGoogle Scholar
Jauniaux, E, Johns, J, Burton, GJ. The role of ultrasound imaging in diagnosing and investigating early pregnancy failure. Ultrasound Obstet Gynecol. 2005;25(6):613–624.CrossRefGoogle ScholarPubMed
Nothnagle, M, Sicilia, JM, Forman, S, et al. Required procedural training in family medicine residency: a consensus statement. Fam Med. 2008;40(4):248–252.Google Scholar
Darney, BG, Weaver, MR, Stevens, N, Kimball, J, Prager, SW. The family medicine residency training initiative in miscarriage management: impact on practice in Washington State. Fam Med. 2013;45(2):102–108.Google ScholarPubMed
Quinley, KE, Chong, D, Prager, S, Wills, CP, Nagdev, A, Kennedy, S. Manual uterine aspiration: adding to the emergency physician stabilization toolkit. Ann Emerg Med. 2018;72(1):86–92.Google Scholar
Kinariwala, M, Quinley, KE, Datner, EM, Schreiber, CA. Manual vacuum aspiration in the emergency department for management of early pregnancy failure. Am J Emerg Med. 2013;31(1):244–247.CrossRefGoogle ScholarPubMed
Dennis, A, Fuentes, L, Douglas-Durham, E, Grossman, D. Barriers to and facilitators of moving miscarriage management out of the operating room. Perspect Sex Reprod Health. 2015;47(3):141–149.CrossRefGoogle Scholar
Darney, BG, Weaver, MR, VanDerhei, D, Stevens, NG, Prager, SW. “One of those areas that people avoid”: a qualitative study of implementation in miscarriage management. BMC Health Serv Res. 2013;13:123.CrossRefGoogle ScholarPubMed
Darney, BG, VanDerhei, D, Weaver, MR, Stevens, NG, Prager, SW. “We have to what?”: lessons learned about engaging support staff in an interprofessional intervention to implement MVA for management of spontaneous abortion. Contraception. 2013;88(2):221–225.Google Scholar
Dalton, VK, Harris, L, Weisman, CS, Guire, K, Castleman, L, Lebovic, D. Patient preferences, satisfaction, and resource use in office evacuation of early pregnancy failure. Obstet Gynecol. 2006;108(1):103–110.CrossRefGoogle ScholarPubMed
Rocconi, RP, Chiang, S, Richter, HE, Straughn, JM. Management strategies for abnormal early pregnancy: a cost-effectiveness analysis. J Reprod Med. 2005;50(7):486–490.Google Scholar
Blumenthal, PD, Remsburg, RE. A time and cost analysis of the management of incomplete abortion with manual vacuum aspiration. Int J Gynaecol Obstet. 1994;45(3):261–267.CrossRefGoogle ScholarPubMed
Marx, J, Hockberger, R, Walls, R. (Eds.). Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia: Elsevier; 2014.Google Scholar
Wittels, KA, Pelletier, AJ, Brown, DFM, Camargo, CA. United States emergency department visits for vaginal bleeding during early pregnancy, 1993–2003. Am J Obstet Gynecol. 2008;198(5):523.e1–6.Google Scholar
ACEP Clinical Policies Committee and Clinical Policies Subcommittee on Early Pregnancy. American College of Emergency Physicians. Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Ann Emerg Med. 2003;41(1):123–133.Google Scholar
Tangsiriwatthana, T, Sangkomkamhang, US, Lumbiganon, P, Laopaiboon, M. Paracervical local anaesthesia for cervical dilatation and uterine intervention. Cochrane Database Syst Rev. 2013;(9):CD005056.CrossRefGoogle Scholar
Renner, R-M, Nichols, MD, Jensen, JT, Li, H, Edelman, AB. Paracervical block for pain control in first-trimester surgical abortion: a randomized controlled trial. Obstet Gynecol. 2012;119(5):1030–1037.CrossRefGoogle ScholarPubMed
Schreiber, CA, Creinin, MD, Atrio, J, Sonalkar, S, Ratcliffe, SJ, Barnhart, KT. Mifepristone pretreatment for the medical management of early pregnancy loss. N Engl J Med. 2018;378(23):2161–2170.CrossRefGoogle ScholarPubMed
Davis, D, O’Brien, MA, Freemantle, N, Wolf, FM, Mazmanian, P, Taylor-Vaisey, A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999;282(9):867–874.CrossRefGoogle ScholarPubMed
Grol, R, Grimshaw, J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003;362(9391):1225–1230.Google Scholar
Dopson, S, FitzGerald, L, Ferlie, E, Gabbay, J, Locock, L. No magic targets! Changing clinical practice to become more evidence based. Health Care Manage Rev. 2010;35(1):2–12.CrossRefGoogle ScholarPubMed
Miscarriage Care Initiative. Reproductive Health Access Project. www.reproductiveaccess.org/programs/mci/. Accessed August 12, 2019.Google Scholar
Early Pregnancy Loss. Innovating education in reproductive health. www.innovating-education.org/category/early-pregnancy-loss/. Accessed August 12, 2019.Google Scholar

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