{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:18:51Z","timestamp":1792239531820,"version":"4.4.0"},"reference-count":34,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Among patients with early pregnancy loss (EPL) without medical complications or need for urgent surgical evacuation, treatment should largely be guided by patient preference. However, evidence describing medication management for EPL in the emergency department (ED) setting is limited. We examine the occurrence of medication management of EPL with misoprostol in an urban Texas ED, describe associated clinical outcomes, and identify patient and clinical factors associated with offering this treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective study of patients with confirmed EPL at a single urban academic ED in Texas from November 1, 2022, to May 31, 2024. Data were collected via relevant EHR review. Eligible patients were identified via ICD\u201010 codes and reviewed using a structured abstraction tool. We identified patients who received expectant or medication management with misoprostol and reported clinical outcomes using descriptive statistics. An exploratory multivariable logistic regression was used to identify characteristics predictive of patients being offered misoprostol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During the study period, 181 patients met our inclusion criteria. Most patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009154; 85.1%) received expectant management. Misoprostol was offered to 44 patients (24%); 27 patients (15.0%) received the medication, all of whom had an OB consult. Seven\u2010day return ED visits were low in both the expectant (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918; 11.5%) and medication (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092; 7.4%) management groups. Of the 18 patients managed expectantly with a 7\u2010day return ED visit, six received misoprostol during the second visit. OB consultation strongly predicted patients being offered misoprostol (aOR 15.1; 95% CI 4.8\u201347.61).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Medication management was rarely provided to ED patients with confirmed EPL; OB was consulted for all patients who received misoprostol. Return ED visits were rare among patients managed expectantly and with misoprostol. Several patients received misoprostol during a return ED visit, which may suggest a missed opportunity for medication treatment of EPL during initial ED presentation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70293","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T13:45:40Z","timestamp":1777297540000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Medication Management of Early Pregnancy Loss in an Urban Texas Emergency Department"],"prefix":"10.1111","volume":"33","author":[{"given":"Lindsay","family":"Cline","sequence":"first","affiliation":[{"name":"Texas A&amp;M University College of Medicine  Bryan Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Sandfeld","sequence":"additional","affiliation":[{"name":"Texas A&amp;M University College of Medicine  Bryan Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley","family":"Brunkal","sequence":"additional","affiliation":[{"name":"Texas A&amp;M University College of Medicine  Bryan Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Fischer","sequence":"additional","affiliation":[{"name":"Independent consultant  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Texas A&amp;M University College of Medicine  Bryan Texas USA"},{"name":"Department of Obstetrics and Gynecology Baylor University Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Fine","sequence":"additional","affiliation":[{"name":"Texas A&amp;M University College of Medicine  Bryan Texas USA"},{"name":"Department of Emergency Medicine Baylor University Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily E.","family":"Ager","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of California San Francisco  San Francisco California USA"},{"name":"National Clinician Scholars Program University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002899"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001753"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2010.10.031"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.324.7342.873"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deh049"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18940"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012602.pub2"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7486"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002253.pub4"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044064"},{"key":"e_1_2_11_12_1","volume-title":"Updated Mifepristone REMS Requirements","author":"American College of Obstetricians & Gynecologists","year":"2025"},{"key":"e_1_2_11_13_1","volume-title":"Information About Mifepristone for Medication Termination of Pregnancy Through Ten Weeks Gestation","author":"U.S. Food & Drug Administration","year":"2025"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1715726"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.35906"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.12549"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2023.110091"},{"key":"e_1_2_11_18_1","unstructured":"March of Dimes \u201cMaternity Care Desert: Texas 2020 \u201dMarch of Dimes PeriStats 2020 https:\/\/www.marchofdimes.org\/peristats\/data?top=23&lev=1&stop=641&reg=99&sreg=48&obj=9&slev=4."},{"key":"e_1_2_11_19_1","unstructured":"March of Dimes \u201cNowhere to Go: Maternity Care Deserts Across the U.S. \u201dMarch of Dimes 2022 https:\/\/www.marchofdimes.org\/sites\/default\/files\/2022\u201010\/2022_Maternity_Care_Report.pdf."},{"key":"e_1_2_11_20_1","unstructured":"A.Stoneburner R.Lucas J.Fontenot C.Brigance E.Jones andA. 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