This randomized trial found that vaginal misoprostol was a safe, effective, and acceptable alternative to surgical evacuation for early pregnancy failure. In the misoprostol group, 71% had complete expulsion by day 3 and 84% by day 8, while treatment failure by day 30 was 16% with misoprostol versus 3% with surgery, with serious complications like hemorrhage or infection being rare in both groups. The authors concluded that 800 micrograms of vaginal misoprostol is a reasonable nonsurgical option, especially because most patients said they would use it again or recommend it.

This article reports a survey of women of childbearing age in two large urban emergency departments. Most expressed interest in receiving both information about and provision of contraception in the ED, with over half indicating they would use such services if available. Those with past barriers to sexual and reproductive health care showing particularly high interest.

This review summarizes the evidence for all EC methods, including copper IUD, UPA, and LNG. It highlights that UPA is slightly more effective than LNG, especially closer to ovulation, and that the copper IUD is nearly 100% effective and provides ongoing contraception. Both oral regimens are safe, with no contraindications, and should be used as soon as possible after unprotected sex.

This randomized trial found that letrozole pretreatment followed by misoprostol was as effective as mifepristone pretreatment followed by misoprostol for the medical management of first-trimester missed miscarriage, with complete evacuation rates of about 98% in both groups. Although tissue expulsion took longer with letrozole, patients had less heavy bleeding afterward and an earlier return of menses, with similar adverse effects and satisfaction rates between groups.

This prospective, observational study found that medication abortion obtained following no-test telehealth screening and mailing of medications was associated with similar rates of complete abortion compared with in-person care with ultrasonography (94.4% vs 93.3%, respectively) and met the 5% noninferiority margin, with a low prevalence of adverse events.

This article provides a practical summary of EC options, including recent evidence that the 52-mg LNG IUD may be noninferior to the copper IUD for EC. It also reviews oral EC regimens, their timing, and considerations for BMI and ongoing contraception.

This review from the Society of Radiologists in Ultrasound outlines evidence-based criteria for diagnosing nonviable pregnancy in the early first trimester using ultrasound and serum hCG measurements. It recommends stricter thresholds, such as a crown-rump length of 7 mm or greater without cardiac activity or a gestational sac of 25 mm or greater without an embryo, to reduce false-positive diagnoses. The article stresses careful interpretation and follow-up so that potentially viable pregnancies are not ended unnecessarily.

This outlines evidence-based strategies for diagnosing and managing ectopic pregnancy, emphasizing the combined use of transvaginal ultrasonography and serial β-hCG measurements rather than reliance on a single value. Management is guided by hemodynamic stability, with urgent surgical intervention for unstable or ruptured cases and methotrexate appropriate for selected stable patients. Expectant management may be considered in carefully monitored individuals with low, declining β-hCG levels, underscoring the importance of individualized care and close follow-up.

This prospective cohort study trained advanced practice providers in the EDs of two pediatric urban academic medical centers to deliver brief contraception counseling. Mean counseling duration was 12 minutes and >90% of reviewed sessions maintained fidelity to content/style. Most participants (61%) reported intention to initiate contraception, and these participants were older and more likely to report prior contraceptive use, compared to those without intention. One-third (33%) initiated contraception in the ED or after the follow-up visit.

This randomized open-label trial compared immediate medical treatment of first-trimester miscarriage with delayed treatment after 1 week of watchful waiting. Delayed treatment led to worse outcomes, including more vacuum aspirations overall (43.5% vs 19.1%), more emergent aspirations, more unplanned emergency visits, and a longer time to complete evacuation. The study concludes that postponing medical treatment increases the likelihood of unplanned surgical intervention, so immediate medical treatment appears more effective than sequential expectant-then-medical management.

5-year retrospective review evaluating race and ethnicity, language, selected socioeconomic indicators, and obesity factors in EC administration. We implemented a quality improvement (QI) initiative over 2 years across three urban EDs, with interventions focused on care standardization. Increased any EC administration from 73.7% to 100% and effective EC from 44.1% to 100%, both of which were sustained for 14 months.

Retrospective case series analysis elevaluating existing protocol for initiating first-trimester medical abortion in the ED at an academic tertiary care center in California. Found initiating medical abortion in the ED feasible, with the potential to address significant healthcare disparities.

The study significance of intrauterine fluid collections in patients with ectopic pregnancy, challenging the assumption that such findings reliably indicate a normal intrauterine gestation. The authors demonstrate that intrauterine fluid may represent a pseudogestational sac and should not exclude the diagnosis of ectopic pregnancy without definitive ultrasonographic evidence of a yolk sac or embryo. The findings reinforce the importance of correlating ultrasound results with clinical presentation and serial β-hCG trends to avoid misdiagnosis and delayed treatment.

Prospective cohort study evaluated the safety and effectiveness of mail-order pharmacy dispensing of mifepristone following in-person screening for medication abortion. The study found that outcomes, including effectiveness and adverse events, were comparable to traditional in-clinic dispensing, supporting mail-order provision as a safe alternative model of care.

This systematic review and network meta-analysis analyzed 46 randomized trials involving 9,250 women to compare treatment options for first-trimester miscarriage. The study found that medical and surgical treatments have similar effectiveness and safety, while expectant management is less effective at achieving complete evacuation. Additionally, combining mifepristone with misoprostol may improve effectiveness and reduce side effects compared with misoprostol alone, though evidence remains limited.

This systematic review evaluates the effectiveness and safety of medical abortion during the early first trimester (up to 63 days) by comparing a combined mifepristone and misoprostol regimen against the use of misoprostol alone. The article synthesizes data to provide evidence-based insights into the clinical outcomes and procedural success of these two common medical termination methods.

This double-blind randomized trial found that mifepristone pretreatment followed by misoprostol was more effective than placebo plus misoprostol for early pregnancy loss after at least one week of expectant management, with complete evacuation in 79.1% versus 58.7% of patients. It also reduced the need for uterine aspiration and was associated with fewer serious adverse events, supporting mifepristone plus misoprostol as a more effective medical regimen for EPL.

This study demonstrated that pretreatment with mifepristone before misoprostol administration significantly increases the success rate of medical management for early pregnancy loss compared to using misoprostol alone. Specifically, women receiving the combination treatment had a higher rate of complete gestational sac expulsion (83.8% vs. 67.1%) and a significantly lower need for subsequent surgical intervention.

The study reevaluates the incidence and clinical significance of pseudogestational sacs in pregnancies of unknown location. Among over 1,200 patients, intrauterine fluid collections were far more commonly associated with intrauterine pregnancies than ectopic pregnancies, and their presence significantly reduced the relative risk of ectopic pregnancy. The authors conclude that pseudogestational sacs are rare, that sac size does not reliably distinguish ectopic from intrauterine gestation, and that diagnosis should incorporate the full clinical and sonographic context rather than reliance on fluid collection characteristics alone.

This 2020 mixed-methods study found that 81% of reproductive-aged women accepted contraception counseling in the ED, with themes supporting ED contraception including addressing unmet needs, contraception being within ED scope, and ED convenience. However, Latina participants had lower acceptance rates, and concerns included contraception being a sensitive topic and the ED potentially being an inappropriate setting for some women.

Editorial piece supporting hormonal IUD placement in ED setting instead of traditionally recommended Plan B, when efficacy may be impacted by patient BMI and other factors.

Retrospective cohort study reviewing data from all female Medicaid enrollees age 18-44 who used short-acting hormonal contraception. Found that medicaid policies requiring coverage of a 12-month supply have not led to substantial increases nationally in prescriptions covering 12-month or longer contraceptive supply.

This highlights updated strategies for managing pregnancy of unknown location (PUL), emphasizing risk stratification and incorporation of pregnancy desiredness to streamline care. It supports triaging low-risk patients—such as those with intrauterine fluid collections or reassuring β-hCG trends—to less intensive follow-up, while recommending active management for undesired or persistent PULs to expedite resolution. The article underscores use of validated prediction models and shared decision-making to reduce unnecessary interventions while safely excluding ectopic pregnancy.

This study by explored women’s experiences with early pregnancy loss (EPL) in the emergency room through semi-structured interviews conducted after ER visits. Findings showed that many women sought ER care due to symptoms like bleeding and uncertainty about their condition, but frequently reported negative experiences, including lack of information, poor communication, and limited emotional support. The study highlights the need for improved patient education, compassionate communication, and clearer follow-up plans to provide more patient-centered care for women experiencing miscarriage.

This paper proposes a structured, team-based approach for emergency departments to offer contraceptive counseling and same-day initiation of desired contraceptive methods during ED visits. They found that EM physicians voluntarily participated in these trainings and integrated the skills learned into their workflow.