Online Program

Expanding Community-based Management of Early Pregnancy Loss

Sunday, November 1, 2015

Lisa M. Maldonado, MA, MPH, Reproductive Health Access Project, New York, NY
Linda Prine, MD, Reproductive Health Access Project, New York, NY
Gabrielle deFiebre, MPH, Reproductive Health Access Project, New York, NY
Diana Romero, PhD, MA, Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, NY
Background: Nearly 1 in 4 women will experience an early pregnancy loss (EPL) during their lifetime. Research shows that EPL can be safely managed in primary care settings. Federally-Qualified Health Centers, also known as Community Health Centers (CHCs), have become the largest national network of primary care providers and provide care to our nation’s most underserved communities. CHCs are required by law to provide comprehensive primary and preventive health care including prenatal care, but there is no data available on EPL services provided by CHCs.

Methods: We obtained a list of all the CHCs in NYS from the Health Resources and Services Administration’s online database. We sent a survey in the mail to all 409 CHC sites in New York State.

Results: The final stages of recruitment are currently underway. Preliminary findings (n= 135) include:

  • Almost half of the sites (45%) provided prenatal care. Of these:
  • Expectant management (92%) was the most likely EPL treatment to be provided, followed by medication management (58%) and uterine aspiration management (25%).
  • Barriers to providing EPL care include: no clinical systems to support this care (67%), uterine aspiration supplies are not stocked at the site (63%), patients are automatically referred outside of the CHC for this care (59%), and no trained provider on-site (50%).
  • Enablers to EPL care include trained staff, existing clinical protocals, onsite champion.

Conclusions: The preliminary findings of our research indicates that many CHCs are providing some miscarriage care, but need to overcome logistical barriers in order to provide comprehensive care.

Learning Areas:

Administer health education strategies, interventions and programs
Clinical medicine applied in public health
Planning of health education strategies, interventions, and programs

Learning Objectives:
Describe the prevalence of early miscarriage in the United States and the role of Community Health Centers in the United States in providing maternal/prenatal care. Describe all three treatment options for managing early pregnancy loss. Identify 3 common barriers and enablers to managing early pregnancy loss in primary care/community health center settings, using national survey data of primary care providers and data from survey of NY federally qualified health centers.

Keyword(s): Prenatal Care, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in the field of reproductive and sexual health for over 20 years. Over the past several years, I have been part of a team of a clinical/research team looking at how management of early pregnancy loss can be better integrated into primary care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.