Early Pregnancy Loss
Introduction
Early Pregnancy Loss (EPL)‐related care accounts for over 900,000 ED visits per year in the U.S. among women aged 15‑441. The EPL in the Emergency Department (ED) training modules were created as part of the Maternal Health ED Toolkit to provide EDs with comprehensive education about the identification and management of EPL and ectopic pregnancies specifically in the ED. It consists of three didactic modules covering best practices for diagnosis and treatment, point-of-care ultrasound use, and strategies to improve patient experiences throughout.
Those who complete the EPL in the ED training on publichealthlearning.com can elect to receive up to 1.25 free Continuing Medical Education (CME) credits. CME credits are accepted by the American Nurses Credentialing Center (ANCC) and other professional accreditation organizations.
Led by CRWG, the training content was developed by FemInEM, with additional support from RADIANT Fellowship and funded by the Illinois Department of Public Health.
1.Benson LS, Magnusson SL, Gray KE, Quinley K, Kessler L, Callegari LS. Early pregnancy loss in the emergency department, 2006-2016. J Am Coll Emerg Physicians Open. 2021;2(6):e12549. Published 2021 Nov 5. doi:10.1002/emp2.12549
Training Content
The entire training only takes 35 minutes to complete but does not need to be finished in one sitting. Participants can pause at any time to return to their place in the future.
Training Modules
Early Pregnancy Loss in the ED
Estimated Completion Time : 14 minutes
Learning objectives:
- Define EPL and recognize disparities in the treatment of EPL in emergency department settings.
- Compare expectant, medical, and procedural management options for EPL and identify appropriate clinical indications for each.
- Apply protocols for the use of mifepristone and misoprostol for medical management of EPL in the ED.
- Describe the benefits, indications, and practical considerations for offering manual uterine aspiration in emergency care.
- Identify communication strategies to improve patient experience, reduce stigma, and provide compassionate, evidence-based EPL care.
Ectopic Pregnancy Management in the Emergency Department
Estimated Completion Time : 14 minutes
Learning objectives:
- Define ectopic pregnancy and describe its prevalence, risk factors, and clinical presentation.
- Identify the key diagnostic criteria for ectopic pregnancy using ultrasound and β-hCG trends.
- Recognize the complications and mortality risks associated with delayed or missed diagnosis of ectopic pregnancy.
- Compare medical and surgical management options, including criteria for methotrexate eligibility and contraindications.
- Implement standardized protocols for early, evidence-based management of ectopic pregnancy in emergency and outpatient settings.
Point-of-Care Ultrasound in Early Pregnancy - Intrauterine Pregnancy Identification & Early Pregnancy Loss
Estimated Completion Time : 6 minutes
Learning objectives:
- Demonstrate appropriate use of point-of-care ultrasound (POCUS) to support clinical decision-making in early pregnancy presentations, including IUD evaluation, pregnancy viability, and ectopic pregnancy.
- Enhance diagnostic confidence and efficiency by integrating POCUS findings with clinical assessment, patient history, and follow-up planning in reproductive health care.
- Recognize sonographic findings that confirm an intrauterine pregnancy (IUP), including gestational sac, yolk sac, and fetal pole across developmental stages.
- Apply ACOG criteria to accurately diagnose early pregnancy loss using measurements such as crown-rump length (CRL) and mean sac diameter (MSD).
- Interpret POCUS findings that indicate nonviability in early pregnancy and differentiate them from inconclusive or indeterminate scans.
Access the Training
The training is available via publichealthlearning.com.
To access:
- Visit publichealthlearning.com
- Create an account
- Receive a confirmation email from publichealthlearning.com
- Note: If you are not receiving emails from the site, they may be going to your SPAM or Junk email folder.
- Click “Course Offerings”
- Select the course “Maternal Health Emergency Department Toolkit”
- Select “Early Pregnancy Loss (EPL) Trainings for Emergency Departments” from the drop-down options.
- Begin!
Questions?
Contact the UIC CRWG team at crwg@uic.edu.
Optional Training
Medication Primer: Mifepristone and Misoprostol
Estimated Completion Time : 8 minutes
Learning objectives:
- Describe the mechanism of action of mifepristone and misoprostol in medication abortion and early pregnancy loss management.
- Summarize the FDA’s Risk Evaluation and Mitigation Strategies (REMS) requirements for mifepristone prescribing and dispensing.
- Compare mifepristone-misoprostol combination therapy versus misoprostol-only protocols for early pregnancy loss.
- Educate patients on expected side effects, symptom progression, and follow-up care after using mifepristone and misoprostol.
- Apply evidence-based guidelines for the safe and effective use of mifepristone and misoprostol in various clinical settings.
Reproductive Rights and Legal Protections in Illinois
Estimated Completion Time : 3 minutes
Learning objectives:
- Recognize the core tenets of the 2019 Reproductive Health Act and how it establishes abortion as a fundamental right without government interference.
- Analyze the impact of repealing the Parental Notification Act and the mandate for public/private insurance coverage on reducing barriers to care for diverse patient populations.
- Describe the protections offered by the 2023 Provider and Patient Protection Act, specifically regarding licensure safeguarding and the authorization of Advanced Practice Clinicians (APCs) in abortion care.
- Contrast evidence-based reproductive care with the tactics of “crisis pregnancy centers” under the Deceptive Practices Related to Limited Services Pregnancy Centers Act.
- Apply the requirements for mandatory emergency medical care (including life-saving abortions) and recognize the strict confidentiality and non-disclosure protocols.
Resources
To access external resources referenced in the modules, please visit the feminem.org website.
About FemInEM
As reproductive and maternal health access continues to erode across the United States and emergency departments increasingly becoming the front lines of care, FemInEM aims to transform the way emergency physicians deliver reproductive healthcare and support the workforce to ensure the highest quality care. The organization does this by equipping emergency medicine professionals with the tools, knowledge, and resources they need to deliver effective care, while also supporting the careers of women in medicine. Learn more about FemInEm on the website.