title: Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care.
abstract: Early pregnancy failure and induced abortion are often managed differently, even though safe uterine evacuation is the goal in both. Early pregnancy failure is commonly treated by curettage in operating room settings in anesthetized patients. Induced abortion is most commonly managed by office vacuum aspiration in awake or sedated patients. Medical evidence does not support routine operating room management of early pregnancy failure. This commentary reviews historical origins of these different care standards, explores political factors responsible for their perpetuation, and uses experience at University of Michigan to dramatize the ways in which history, politics, and biomedicine intersect to produce patient care. The University of Michigan initiated office uterine evacuations for early pregnancy failure treatment. Patients previously went to the operating room. These changes required faculty, staff, and resident education. Our efforts blurred the lines between spontaneous and induced abortion management, improved patient care and better utilized hospital resources.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Harris
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
authors.forename: Timothy R B
authors.initials: TR
authors.lastname: Johnson
mesh_terms: D000019:Abortifacient Agents / Q000627:therapeutic use; D000027:Abortion, Incomplete / Q000188:drug therapy / Q000601:surgery*; D000028:Abortion, Induced / Q000191:economics / Q000266:history / Q000331:legislation & jurisprudence / Q000379:methods*; D000556:Ambulatory Surgical Procedures; D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D011057:Politics; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D014481:United States; D014619:Vacuum Curettage / Q000266:history / Q000331:legislation & jurisprudence
chemical_list: D000019:Abortifacient Agents