Emergency Physician Practices, Knowledge, and Attitudes Toward Early Pregnancy Loss Management

Early pregnancy loss (EPL) is the most common pregnancy complication, accounting for approximately 900,000 emergency department (ED) visits annually. Although expectant, medication, and procedural management are all evidence-based options, ED patients are less likely to receive medication or procedural management than those in ambulatory settings. These findings display a gap in the receipt of evidence-based treatment among patients receiving ED care. We sought to characterize emergency physician (EP) knowledge, attitudes, and perceived barriers to comprehensive EPL management in the ED.

We conducted a national cross-sectional survey of practicing U.S. EPs from September–December 2025. The survey assessed demographics, practice characteristics, EPL management practices, institutional resources, and attitudes using 3-point Likert scales. Analyses included descriptive statistics and group comparisons using chi-square tests, stratified by physicians providing only expectant management versus those also providing medication or procedural management.

Among 177 respondents from 30 states, most practiced in urban settings (66.7%) and academic (45.2%), community (27.7%), or hybrid (16.9%) environments. Half reported providing medication management (51.1% misoprostol only and 48.9% combination mifepristone-misoprostol) and 5.1% procedural management. Nearly 40% were unaware of institutional mifepristone availability, and only 52.5% correctly identified combination therapy as standard of care. Physicians providing medication or procedural care were more likely to practice in settings with an EPL protocol (29.8% vs 11.9%; p=0.009), to be aware of mifepristone access (63.8% vs 45.2%; p=0.042), to consider using an institutional protocol (83.0% vs 60.7%; p=0.003), and less likely to perceive EPL care as challenging (43.6% vs 65.5%;p=0.010). Aside from race/ethnicity, demographic and practice characteristics were not associated with differences in management.

Provision of medical or procedural EPL care in the ED was more strongly associated with institutional resources (e.g., protocols and medication access) than physician or practice characteristics. Institutional interventions promoting standard, evidence-based EPL management represent a key opportunity to improve ED care and align practice with established standards.