Surgical management in the office for first-trimester miscarriage is a safe and effective option for women, according to the presenters of the Sunday morning Clinical Seminar “Surgical Miscarriage Management in the Office—You Can Do It!”
Rachel B. Rapkin, MD, MPH, assistant professor of obstetrics and gynecology at the University of South Florida, and Christy M. Boraas, MD, MPH, assistant professor in the department of obstetrics and gynecology at the University of Minnesota, reviewed the advantages of providing surgical management to early pregnancy loss, or miscarriage management with manual vacuum aspiration (MVA), and steps to implementing the service in office.
“Patient preference and choice is so important, and we need to be able to offer this to our patients if this is what they desire,” Dr. Rapkin said. “There’s no difference in effectiveness, so we can’t say ‘You’re less likely to need a follow up if we do it in the OR.’ That’s not true at all. You’re just as likely to succeed if you do this procedure in the office.”
There’s no question that it’s also a cost saving, she said. MVA in the office is $793 per cure while in the OR is $2,333 per cure, according to a study published in The Journal of Reproductive Medicine in 2005.
There are challenges that prevent gynecologists and patients from choosing this procedure and including clinic space considerations, staff participation, clinic flow, implementation challenges, and pain control.
Once the decision has been made to offer an office-based procedure, it’s important to consider all aspects of implementation, including supplies, administrative support, finance billing departments, and assembling a project team.
“Staying on top of who is going to be ordering the tools or who is going to be in charge of ensuring those come back to your shelf if you send them away for processing is important,” she said. “Staying on top of clinic staffing meetings, again reminding people of the evidence of why this is an important choice for women, and when new hires come on, really engaging them in this service that you offer is also really important.”
Scheduling should also be considered when implementing the service.
For an implementation phase, Dr. Boraas suggested identifying a half day or two half days for the procedure with a small handful of physicians who are going to be in charge of the roll out as a way to provide staffing consistency. Although the procedure is fast, recovery time and emotional well-being of the woman should be taken into account for appointment time.
“Having other supportive measures like a heating pad, learning how to give gentle massages, and allowing the patient to bring into the room whatever she thinks will help her with the procedure is really important,” Dr. Boraas said.
Drs. Boraas and Rapkin hoped to empower the audience to offer MVA in the office, but reminded them that patient preference is crucial.
“Before you do anything, make sure that the patient is properly diagnosed because there are early pregnancy laws, that you discuss all the patient treatment options with her, and know that she may have specific preferences,” Dr. Rapkin said.