Analgesia and supportive care
›Symptom control
›Acetaminophen 1,000 mg PO
›Maximum 4,000 mg per 24 hours from all sources
›Ibuprofen 400 to 600 mg PO if no contraindication
›Avoid if significant renal disease or gastritis
›Ondansetron 4 to 8 mg PO or IV for nausea
›Hemorrhage supportive care
›Isotonic crystalloid bolus 500 to 1,000 mL IV for symptomatic hypovolemia
›Blood products per hemorrhage severity and ongoing loss
Threatened abortion management
›Threatened abortion care goals
›Maternal stabilization
›Ectopic exclusion
›Viability assessment
›Expectant management as default if viable intrauterine pregnancy and stable
›Activity and pelvic considerations
›Pelvic rest guidance as symptom based counseling option
›Avoid intravaginal products until bleeding resolves
›Progesterone therapy selected patients
›Vaginal bleeding in early pregnancy with prior miscarriage history
›Vaginal progesterone 400 mg twice daily
›Continue until 16 weeks gestation if ongoing pregnancy per local guidance
›Contraindications and cautions
›Uncertain diagnosis of ectopic pregnancy
›Severe liver disease
›Rh immune globulin
›Rh negative or unknown with vaginal bleeding
›Rh immune globulin dosing per gestational age and local product
›Up to 12 weeks gestation
›50 micrograms IM if available
›300 micrograms IM acceptable alternative
›Beyond 12 weeks gestation
›300 micrograms IM
Inevitable and incomplete abortion management options
›Treatment selection framework
›Expectant management option
›Stable patient
›No infection signs
›Bleeding not heavy
›Medical management option
›Stable patient
›No infection signs
›Preference to avoid procedure
›Procedural management option
›Heavy bleeding
›Hemodynamic instability
›Suspected retained products with hemorrhage
›Infection concern
›Patient preference for rapid completion
›Expectant management details
›Anticipated cramping and bleeding
›Return precautions for hemorrhage and infection
›Follow up plan for symptom resolution confirmation
›Medical management regimen for early pregnancy loss
›Mifepristone and misoprostol regimen if available
›Mifepristone 200 mg PO once
›Followed in 24 hours by misoprostol 800 micrograms
›Vaginal route option
›Buccal route option
›Misoprostol only regimen if mifepristone unavailable
›Misoprostol 800 micrograms vaginal or buccal
›Repeat misoprostol 800 micrograms after 3 to 24 hours if needed
›Medication counseling
›Expected peak cramping and bleeding within hours of misoprostol
›Fever and chills transient after misoprostol possible
›Persistent fever beyond 24 hours as infection warning
›Procedural management
›Manual vacuum aspiration suction curettage
›Preferred for rapid completion and hemorrhage control in many settings
›Dilation and curettage
›Operating room pathway if unstable or complex
›Cervical tissue removal
›Products at cervical os with brisk bleeding
›Immediate obstetrics and gynecology involvement
›Antibiotics for septic abortion or high suspicion infection
›Broad spectrum IV regimen
›Ampicillin 2 g IV every 6 hours
›Gentamicin 5 mg per kg IV daily
›Clindamycin 900 mg IV every 8 hours
›Alternative if beta lactam allergy
›Clindamycin 900 mg IV every 8 hours
›Gentamicin 5 mg per kg IV daily
›Source control requirement
›Urgent uterine evacuation
›Anti D immune prophylaxis after miscarriage management
›Rh negative or unknown with miscarriage
›Rh immune globulin dosing per gestational age and local product