Early pregnancy care in North America: A proposal for high-value care that can level health disparities

Jade M Shorter,Helen Pymar,Sarah Prager,Arden Mcallister,Courtney A Schreiber

doi:10.1016/j.contraception.2021.04.015

Jade M Shorter, Helen Pymar + Show 3 more

https://doi.org/10.1016/j.contraception.2021.04.015

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In the United States, approximately 40% of pregnancies do not result in a birth, and instead end in induced or spontaneous abortion [ 1 Casterline JB. Collecting data on pregnancy loss: a review of evidence from the World Fertility Survey. Stud Fam Plann. 1989; 20: 81-95 Crossref PubMed Scopus (51) Google Scholar , 2 Jones RK Jerman J. Abortion incidence and service availability in the United States, 2014. Perspect Sex Reprod Health. 2017; 49: 17-27 Crossref PubMed Scopus (209) Google Scholar , 3 Jones RK Jerman J. Population group abortion rates and lifetime incidence of abortion: United States, 2008-2014. Am J Public Health. 2017; 107: 1904-1909 Crossref PubMed Scopus (106) Google Scholar ]. These pregnant patients often present for early pregnancy care before initiation of traditional prenatal care in a variety of clinical venues and are transitional between gynecology and obstetrics [ [4] Miller CA Roe AH McAllister A Meisel ZF Koelper N Schreiber CA. Patient experiences with miscarriage management in the emergency and ambulatory settings. Obstet Gynecol. 2019; 134: 1285-1292 Crossref PubMed Scopus (9) Google Scholar , [5] Wittels KA Pelletier AJ Brown DF Camargo Jr., CA United States emergency department visits for vaginal bleeding during early pregnancy, 1993-2003. Am J Obstet Gynecol. 2008; 198 (e1-6): 523 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ]. Early pregnancy care encompasses pregnancy options counseling; pregnancy dating; evaluation of common concerns such as bleeding and/or pain; and the assessment and management of early pregnancy loss, pregnancy of unknown location, and ectopic pregnancy, as well as early surveillance for patients at high risk for these outcomes. This commentary will describe early pregnancy care delivery in other countries, and a high-value model emerging from the unification of family planning services with early pregnancy evaluation and management. Combining this care into one setting can save resources, decrease care variability, and improve patient-centered care.

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