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Abstract
Discussion Forum (0)
Introduction:
Compared to misoprostol alone, medical management of early pregnancy loss (EPL) with mifepristone and misoprostol has a 25% higher success rate, reduces subsequent uterine aspiration, and is cost-effective. During the COVID-19 pandemic, we began providing mifepristone and misoprostol for EPL in our urban Emergency Departments (EDs), aiming to increase access to essential services and to minimize repeated healthcare visits. We sought to describe the safety and efficacy of this novel practice.

Methods:
We retrospectively reviewed the charts of all patients receiving mifepristone and misoprostol for first trimester pregnancy management in our EDs between April 2020 and March 2021 (n=33) with IRB approval. Effective treatment was defined as pregnancy resolution after a single treatment with mifepristone and misoprostol. Safety outcomes included need for additional management, emergent surgical interventions, and blood transfusion. Descriptive statistics and univariate analysis were performed.

Results:
The prevalence of effective treatment was 70% (n=23). Among the 10 subjects (30%) requiring additional management, interventions were: one additional dose of misoprostol (n=4), uterine aspiration (n=4), methotrexate (n=1), and uterine artery embolization (n=1). Three interventions (30%) were emergent, and two of these patients also required transfusion. Demographic characteristics were not associated with effective treatment nor with safety outcomes. Twenty-eight subjects (84%) participated in follow-up; 17 via telemedicine and 11 in person.

Conclusion/Implications:
Providing mifepristone and misoprostol for EPL in the ED may be an effective method to increase healthcare access. Further research is needed to determine whether this population is truly at increased risk for serious complications.
Introduction:
Compared to misoprostol alone, medical management of early pregnancy loss (EPL) with mifepristone and misoprostol has a 25% higher success rate, reduces subsequent uterine aspiration, and is cost-effective. During the COVID-19 pandemic, we began providing mifepristone and misoprostol for EPL in our urban Emergency Departments (EDs), aiming to increase access to essential services and to minimize repeated healthcare visits. We sought to describe the safety and efficacy of this novel practice.

Methods:
We retrospectively reviewed the charts of all patients receiving mifepristone and misoprostol for first trimester pregnancy management in our EDs between April 2020 and March 2021 (n=33) with IRB approval. Effective treatment was defined as pregnancy resolution after a single treatment with mifepristone and misoprostol. Safety outcomes included need for additional management, emergent surgical interventions, and blood transfusion. Descriptive statistics and univariate analysis were performed.

Results:
The prevalence of effective treatment was 70% (n=23). Among the 10 subjects (30%) requiring additional management, interventions were: one additional dose of misoprostol (n=4), uterine aspiration (n=4), methotrexate (n=1), and uterine artery embolization (n=1). Three interventions (30%) were emergent, and two of these patients also required transfusion. Demographic characteristics were not associated with effective treatment nor with safety outcomes. Twenty-eight subjects (84%) participated in follow-up; 17 via telemedicine and 11 in person.

Conclusion/Implications:
Providing mifepristone and misoprostol for EPL in the ED may be an effective method to increase healthcare access. Further research is needed to determine whether this population is truly at increased risk for serious complications.
Providing mifepristone and misoprostol in emergency departments during the COVID-19 pandemic
Dr. Roselle Bleck
Dr. Roselle Bleck
Affiliations:
Montefiore Medical Center
ACOG ePoster. Bleck R. 05/06/2022; 351032; A008
user
Dr. Roselle Bleck
Affiliations:
Montefiore Medical Center
Abstract
Discussion Forum (0)
Introduction:
Compared to misoprostol alone, medical management of early pregnancy loss (EPL) with mifepristone and misoprostol has a 25% higher success rate, reduces subsequent uterine aspiration, and is cost-effective. During the COVID-19 pandemic, we began providing mifepristone and misoprostol for EPL in our urban Emergency Departments (EDs), aiming to increase access to essential services and to minimize repeated healthcare visits. We sought to describe the safety and efficacy of this novel practice.

Methods:
We retrospectively reviewed the charts of all patients receiving mifepristone and misoprostol for first trimester pregnancy management in our EDs between April 2020 and March 2021 (n=33) with IRB approval. Effective treatment was defined as pregnancy resolution after a single treatment with mifepristone and misoprostol. Safety outcomes included need for additional management, emergent surgical interventions, and blood transfusion. Descriptive statistics and univariate analysis were performed.

Results:
The prevalence of effective treatment was 70% (n=23). Among the 10 subjects (30%) requiring additional management, interventions were: one additional dose of misoprostol (n=4), uterine aspiration (n=4), methotrexate (n=1), and uterine artery embolization (n=1). Three interventions (30%) were emergent, and two of these patients also required transfusion. Demographic characteristics were not associated with effective treatment nor with safety outcomes. Twenty-eight subjects (84%) participated in follow-up; 17 via telemedicine and 11 in person.

Conclusion/Implications:
Providing mifepristone and misoprostol for EPL in the ED may be an effective method to increase healthcare access. Further research is needed to determine whether this population is truly at increased risk for serious complications.
Introduction:
Compared to misoprostol alone, medical management of early pregnancy loss (EPL) with mifepristone and misoprostol has a 25% higher success rate, reduces subsequent uterine aspiration, and is cost-effective. During the COVID-19 pandemic, we began providing mifepristone and misoprostol for EPL in our urban Emergency Departments (EDs), aiming to increase access to essential services and to minimize repeated healthcare visits. We sought to describe the safety and efficacy of this novel practice.

Methods:
We retrospectively reviewed the charts of all patients receiving mifepristone and misoprostol for first trimester pregnancy management in our EDs between April 2020 and March 2021 (n=33) with IRB approval. Effective treatment was defined as pregnancy resolution after a single treatment with mifepristone and misoprostol. Safety outcomes included need for additional management, emergent surgical interventions, and blood transfusion. Descriptive statistics and univariate analysis were performed.

Results:
The prevalence of effective treatment was 70% (n=23). Among the 10 subjects (30%) requiring additional management, interventions were: one additional dose of misoprostol (n=4), uterine aspiration (n=4), methotrexate (n=1), and uterine artery embolization (n=1). Three interventions (30%) were emergent, and two of these patients also required transfusion. Demographic characteristics were not associated with effective treatment nor with safety outcomes. Twenty-eight subjects (84%) participated in follow-up; 17 via telemedicine and 11 in person.

Conclusion/Implications:
Providing mifepristone and misoprostol for EPL in the ED may be an effective method to increase healthcare access. Further research is needed to determine whether this population is truly at increased risk for serious complications.

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