Spontaneous abortion in primary care. A report from ASPN.
The Ambulatory Sentinel Practice Network (ASPN) conducted an observational study of usual primary care of spontaneous abortion (SAB). Forty-nine practices in 18 states and four Canadian provinces reported and audited 171 SABs. Contrary to recommendations in some texts, 40 percent were managed completely in the office and/or at home, and only 51 percent had a dilation and curettage (D&C). SABs occurring later in pregnancy were more likely to be managed in the emergency room/hospital, receive consultation, and have a D&C. Patients managed with D&C had a greater frequency of excessive blood loss at diagnosis, but otherwise they did not differ in terms of complications at diagnosis or follow-up from those who did not. Adverse psychological consequences were subjectively observed by ASPN clinicians in 24 percent of women, exceeding any other category of complications. Management of all SABs in a hospital with D&C, instead of the management observed in this study, could add $145,000,000 per year to health care expenditures in the United States.
D000022:Abortion, Spontaneous / Q000628:therapy*; D000553:Ambulatory Care; D002170:Canada; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care; D004107:Dilatation and Curettage; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D011247:Pregnancy; D011320:Primary Health Care; D014481:United States