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Early pregnancy loss can be treated medically with mifepristone followed by misoprostol, with ultrasonographic confirmation of pregnancy expulsion. Alternative strategies that ascertain treatment success remotely are needed. We compared percent decline in human chorionic gonadotropin (hCG) level with treatment success or failure between patients who received mifepristone pretreatment followed by misoprostol or misoprostol alone for early pregnancy loss between 5 and 12 weeks of gestation to determine a threshold decline that might predict success. Early pregnancy loss treatment success was associated with a greater percent hCG level decline compared with treatment failure, but no threshold was able to predict success. Additional research is needed to understand hCG trends after medical management of early pregnancy loss to develop reliable protocols for remote follow-up.

Clinically stable miscarriage patients presenting to the emergency department have baseline socioeconomic disadvantages and are less satisfied than those presenting to ambulatory clinics., OBJECTIVE: To quantitatively and qualitatively describe the patient experience for clinically stable patients presenting with miscarriage to the emergency department (ED) or ambulatory clinics. METHODS: We present a subanalysis of a mixed-methods study from 2016 on factors that influence miscarriage treatment decision-making among clinically stable patients. Fifty-four patients were evaluated based on location of miscarriage care (ED or ambulatory-only), and novel parameters were assessed including timeline (days) from presentation to miscarriage resolution, number of health system interactions, and number of specialty-based provider care teams seen. We explored themes around patient satisfaction through in-depth narrative interviews. RESULTS: Median time to miscarriage resolution was 11 days (range 5–57) (ED) and 8 days (range 0–47) (ambulatory-only). We recorded a mean of 4.4±1.4 (ED) and 3.0±1.2 (ambulatory-only) separate care teams and a median of 13 (range 8–20) (ED) and 19 (range 8–22) (ambulatory-only) health system interactions. Patients seeking care in the ED were younger (28.3 vs 34.0, odds ratio [OR] 5.8, 95% CI 1.8–18.7), more likely to be of black race (28.3 vs 34.0, OR 3.3, 95% CI 1.1–10.0), uninsured or insured through Medicaid (16 vs 6, OR 6.8, 95% CI 2.1–22.5), and more likely to meet criteria for posttraumatic stress disorder when compared with ambulatory-only patients (10 vs 3, OR 6.0, 95% CI 1.5–23.4). Patients valued diagnostic clarity, timeliness, and individualized care. We found that ED patients reported a lack of clarity surrounding their diagnosis, inefficient care, and a mixed experience with health care provider sensitivity. In contrast, ambulatory-only patients described a streamlined and sensitive care experience. CONCLUSION: Patients seeking miscarriage care in the ED were more likely to be socioeconomically and psychosocially vulnerable and were less satisfied with their care compared with those seen in the ambulatory setting alone. Expedited evaluation of early pregnancy problems, with attention to clear communication and emotional sensitivity, may optimize the patient experience.

INTRODUCTION: As the median age of survival of women with cystic fibrosis rises reproductive health has become increasingly important in this population. We sought to characterize contraceptive preferences and use among adult females with cystic fibrosis (CF). METHODS: We used questions from previously validated surveys to build an instrument that assessed reproductive health and contraceptive variables. Female participants ages 17-45 years were recruited through the electronic mailing list of the Penn Adult CF Program. RESULTS: Fifty-three of 100 adult female patients with CF have responded to date. Eighty-three percent are sexually active and 31% have been pregnant. Twenty-two percent of reported pregnancies resulted in abortion secondary to either unplanned pregnancy or suboptimal health status. Forty-nine percent of participants use contraception. Condoms (35%) and oral contraceptive pills (27%) are most commonly used. Respondents prioritize effectiveness and ease of use in their contraceptive method; they want to avoid side effects medication interactions and diminished sexual enjoyment. CONCLUSION: Our CF population is sexually active but contraceptive use is low and unplanned and mistimed pregnancies are common. Uptake of contraceptive methods that fit these womens preferences is low. There is significant unmet need for contraception in this population.