Effects of an Early Pregnancy Assessment Clinic (EPAC) on the Management of Spontaneous Abortions

Acceptability of Mifepristone and Misoprostol and Patients' Experience With the Early Pregnancy Assessment Clinic at a Community Hospital in Canada

OBJECTIVES

Early pregnancy loss (EPL) is a common complication of pregnancy. Research has demonstrated the efficacy of mifepristone pre-treatment followed by misoprostol for the induction of an EPL. North York General Hospital (NYGH) provides an all-in-one Early Pregnancy Assessment Clinic (EPAC) to streamline the care of women with an EPL.

METHODS

We conducted a prospective single cohort qualitative survey to understand patients' satisfaction with mifepristone and misoprostol and their experience with EPAC at NYGH. We recruited 191 patients with a confirmed EPL. They were given mifepristone and misoprostol. We administered the validated modified version of the Short Form-36 Health Survey Revised quality of life scales questionnaire to study the following outcomes: (1) acceptability of mifepristone and misoprostol: cramping, bleeding, duration of treatment, and recommendation to others; (2) effect on social activities; and (3) participants' overall satisfaction with the EPAC at NYGH.

RESULTS

We found that 96% of our participants responded completely to our questionnaire. For cramping, 24% reported definitely acceptable, whereas 8% definitely unacceptable. For bleeding, 26% reported definitely acceptable, whereas 4.8% definitely unacceptable. For duration of treatment, 27% reported definitely acceptable and 2.7% definitely unacceptable. Finally, for recommendation to others, 41% reported definitely acceptable and 2.1% definitely unacceptable. The rating for NYGH's EPAC was high, with 68% of participants rating it as excellent.

CONCLUSIONS

We found that the acceptability of the medical management at our EPAC for an EPL is high with the mifepristone and misoprostol protocol. This study encourages this treatment and the establishment of similar centres.

Experiences and outcomes of women with bleeding in early pregnancy presenting to the Emergency Department: An integrative review

BACKGROUND

Bleeding in early pregnancy occurs in approximately a quarter of all pregnancies and is a common reason for presentation to the Emergency Department (ED). This review combined current knowledge about experiences, interventions, outcomes and frequency of women presenting to the ED with per vaginal (PV) bleeding in the first 20 weeks of pregnancy.

METHODS

This integrative literature review was conducted using electronic database and hand searching methods for primary research published from 2000; followed by screening and appraisal. Articles were compared and grouped to identify characteristics and patterns that guided the synthesis of categories.

RESULTS

Forty-two primary research articles met inclusion criteria. Four main categories related to experiences and outcomes of women with bleeding in early pregnancy presenting to the ED were identified: presentation frequency and characteristics; women and their partners' experiences in the ED; interventions and treatments; patient and health service outcomes.

CONCLUSIONS

Negative and often frustrating experiences are reported by women experiencing PV bleeding, their partners and ED healthcare providers. While strategies such as early pregnancy assessment services contribute to improved outcomes, the availability of these services vary. Further research is needed to identify specific needs of this group of women and their partners, and the staff providing their care in the ED, to inform strategies for improved quality of care.