Managing early pregnancy loss in primary care: Findings from mixed-method research with family physicians trained in uterine aspiration

Background: While research shows that miscarriage can be safely managed in primary care settings, many women continue to use the Emergency Room (ER) for evaluation and treatment of early pregnancy bleeding.  To understand the factors affecting miscarriage care in primary care settings we conducted a mixed-method study with family physicians (FPs) trained in all three early pregnancy loss treatment options during residency.

Methods: In-depth interviews were conducted with 15 FPs and analyzed using Dedoose software. Qualitative research findings informed the development of a web-based survey which was disseminated to over 500 FPs trained in all three options for managing early pregnancy loss. 

Results: Data analysis of the survey is currently underway.

Preliminary findings from both the qualitative and quantitative studies (n= 142) include:

• Expectant management (85.2%) was the most likely treatment to be provided, followed by medication management (58.5%) and uterine aspiration (15.5%).
• Onsite or easy access to ultrasounds facilitates medication and uterine aspiration treatment (44.7% and 63.6% respectively).
• Strong clinical leadership existed in sites providing all three treatment options (qualitative interviews).
• Barriers to providing uterine aspiration include: need for more/refresher training (36.7%), equipment, supplies and adequate space (36.7%); logistical considerations (35%); and that the practice sends patients to an ob/gyn for management (33.3%).

Conclusions: The preliminary findings of our research indicates that transitioning miscarriage care from the ER to primary care settings requires strengthening FP training in all three treatment options and addressing logistical requirements in clinical settings.