Abstract：
OBJECTIVE: To evaluate the implementation of mifepristone and misoprostol for medical management of early pregnancy loss (EPL) in emergency departments (EDs) by comparing efficacy, complication, and follow-up rates for patients treated in EDs to the Complex Family Planning (CFP) outpatient office.
METHODS: In COVID-19\'s first wave, we expanded medical management of EPL to our EDs. This retrospective study evaluated 72 patients receiving mifepristone and misoprostol for EPL from April 1, 2020 to March 31, 2021, comparing treatment success, safety outcomes, and follow-up rates by location.
RESULTS: Thirty-three (46%) patients received care in the ED and 39 (54%) at CFP. Treatment success was lower in EDs (23, 70%) compared to CFP (34, 87%), but after adjusting for insurance status and pregnancy type (miscarriage, uncertain viability, unknown location), this was not significant: adjusted odds ratio 0.48 (95% CI 0.13-1.81). More ED patients underwent emergent interventions (3 vs 0) including two emergent uterine aspirations, one uterine artery embolization, and two blood transfusions. Two cases were attributed to misdiagnosis (cesarean scar and cervical ectopic pregnancies interpreted as incomplete miscarriages) and one to guideline nonadherence. No complications occurred in the CFP group. Follow-up rates were over 80% in both groups. More ED patients engaged in telehealth follow-up (67% vs 18%, p ≤ 0.0001).
CONCLUSIONS: In this small sample, we observed a trend toward less successful treatment in the ED compared to the CFP office. Both correctly making uncommon diagnoses and adhering to new guidelines presented implementation challenges.
CONCLUSIONS: Implementing mifepristone and misoprostol for EPL in our EDs achieved lower rates of pregnancy resolution compared to outpatient management. Complex uncommon diagnoses and implementing new care pathways in EDs may have contributed to complications and highlighted opportunities for improvement. Additional studies are needed to further quantify safety outcomes for EPL management in EDs.
METHODS: In COVID-19\'s first wave, we expanded medical management of EPL to our EDs. This retrospective study evaluated 72 patients receiving mifepristone and misoprostol for EPL from April 1, 2020 to March 31, 2021, comparing treatment success, safety outcomes, and follow-up rates by location.
RESULTS: Thirty-three (46%) patients received care in the ED and 39 (54%) at CFP. Treatment success was lower in EDs (23, 70%) compared to CFP (34, 87%), but after adjusting for insurance status and pregnancy type (miscarriage, uncertain viability, unknown location), this was not significant: adjusted odds ratio 0.48 (95% CI 0.13-1.81). More ED patients underwent emergent interventions (3 vs 0) including two emergent uterine aspirations, one uterine artery embolization, and two blood transfusions. Two cases were attributed to misdiagnosis (cesarean scar and cervical ectopic pregnancies interpreted as incomplete miscarriages) and one to guideline nonadherence. No complications occurred in the CFP group. Follow-up rates were over 80% in both groups. More ED patients engaged in telehealth follow-up (67% vs 18%, p ≤ 0.0001).
CONCLUSIONS: In this small sample, we observed a trend toward less successful treatment in the ED compared to the CFP office. Both correctly making uncommon diagnoses and adhering to new guidelines presented implementation challenges.
CONCLUSIONS: Implementing mifepristone and misoprostol for EPL in our EDs achieved lower rates of pregnancy resolution compared to outpatient management. Complex uncommon diagnoses and implementing new care pathways in EDs may have contributed to complications and highlighted opportunities for improvement. Additional studies are needed to further quantify safety outcomes for EPL management in EDs.
摘要：
目的：通过疗效比较，评价米非司酮和米索前列醇在急诊科早期妊娠丢失(EPL)医疗管理中的应用效果。并发症,以及在ED中接受治疗的患者与在复杂计划生育（CFP）门诊中接受治疗的患者的随访率。
方法：在COVID-19的第一波中，我们将EPL的药物管理扩展到我们的ED。这项回顾性研究评估了从2020年4月1日至2021年3月31日接受米非司酮和米索前列醇用于EPL的72例患者，比较了治疗成功率。安全结果，以及按地点划分的随访率。我们没有进行功率计算。
结果：33例（46%）患者接受了ED治疗，39例（54%）患者接受了CFP治疗。ED（23，70％）的治疗成功率低于CFP（34，87.2％），但在调整保险状况和怀孕类型后(流产，不确定的可行性，未知位置）这并不显著：aOR0.48（95CI0.13-1.81），p=0.28。更多的ED患者接受了紧急干预(3vs0)。ED队列中的并发症包括两个紧急子宫抽吸，一个子宫动脉栓塞,和两次输血.其中,2例误诊(剖宫产瘢痕和宫颈异位妊娠被解释为不完全流产),1例误诊为指南依从性不良(抗凝患者).CFP组无并发症发生。两组的随访率均超过80%。更多的ED患者从事远程医疗随访(67%vs18.0%，p≤0.0001)。
结论：在这个小样本中，我们观察到ED中EPL药物管理后治疗成功率下降的趋势，与CFP办公室相比。此分析强调，正确地进行不寻常的诊断和坚持新的指导方针都在我们的实施过程中提出了挑战。
结论：在我们的ED中实施米非司酮和米索前列醇用于EPL的妊娠消退率低于门诊治疗。复杂的罕见诊断和在ED中实施新的护理途径可能导致并发症并突出改善的机会。需要更多的研究来进一步量化EDEPL管理的安全性结果。
结论：在COVID-19期间提供米非司酮和米索前列醇治疗早期妊娠丢失的效果不如门诊治疗。ED组因误诊和指南不遵守而出现更严重的并发症。
方法：在COVID-19的第一波中，我们将EPL的药物管理扩展到我们的ED。这项回顾性研究评估了从2020年4月1日至2021年3月31日接受米非司酮和米索前列醇用于EPL的72例患者，比较了治疗成功率。安全结果，以及按地点划分的随访率。我们没有进行功率计算。
结果：33例（46%）患者接受了ED治疗，39例（54%）患者接受了CFP治疗。ED（23，70％）的治疗成功率低于CFP（34，87.2％），但在调整保险状况和怀孕类型后(流产，不确定的可行性，未知位置）这并不显著：aOR0.48（95CI0.13-1.81），p=0.28。更多的ED患者接受了紧急干预(3vs0)。ED队列中的并发症包括两个紧急子宫抽吸，一个子宫动脉栓塞,和两次输血.其中,2例误诊(剖宫产瘢痕和宫颈异位妊娠被解释为不完全流产),1例误诊为指南依从性不良(抗凝患者).CFP组无并发症发生。两组的随访率均超过80%。更多的ED患者从事远程医疗随访(67%vs18.0%，p≤0.0001)。
结论：在这个小样本中，我们观察到ED中EPL药物管理后治疗成功率下降的趋势，与CFP办公室相比。此分析强调，正确地进行不寻常的诊断和坚持新的指导方针都在我们的实施过程中提出了挑战。
结论：在我们的ED中实施米非司酮和米索前列醇用于EPL的妊娠消退率低于门诊治疗。复杂的罕见诊断和在ED中实施新的护理途径可能导致并发症并突出改善的机会。需要更多的研究来进一步量化EDEPL管理的安全性结果。
结论：在COVID-19期间提供米非司酮和米索前列醇治疗早期妊娠丢失的效果不如门诊治疗。ED组因误诊和指南不遵守而出现更严重的并发症。
