A Canadian Medical Association Journal review published in October 2024 argued that many patients experiencing early pregnancy loss receive delayed, fragmented or insufficiently compassionate care in crowded emergency departments. Miscarriage is common, but the authors said access to specialized assessment and clear follow-up remains inconsistent.
How common early pregnancy loss is
Estimates vary by how pregnancy and loss are identified, but up to about 20 per cent of recognized pregnancies end in miscarriage. Many losses occur early, sometimes before a person knows they are pregnant.
The review described early pregnancy loss before 13 weeks as an empty gestational sac or an embryo without cardiac activity. Symptoms can include vaginal bleeding, cramping, pelvic or abdominal pain and passage of tissue.
Why patients turn to emergency rooms
People may not have a family physician, cannot obtain same-day obstetric care or do not know whether their symptoms are dangerous. The emergency department is always appropriate for severe bleeding, intense or one-sided pain, fainting, marked weakness or other signs of an emergency.
Ectopic pregnancy and major hemorrhage can be life-threatening and may initially resemble miscarriage. No article or telephone advice can safely diagnose the cause of bleeding for an individual patient.
The experience of waiting
A medically stable patient can face hours in a public waiting room while more immediately life-threatening cases are treated first. That triage order may be clinically necessary, but the setting can intensify pain, uncertainty and grief.
Patients have described feeling that they were wasting staff time when symptoms were not dramatic. A private area, regular updates and acknowledgment of the loss can improve care even when the clinical wait cannot be eliminated.
Consequences beyond the physical event
Co-author Dr. Modupe Tunde-Byass said a perceived lack of compassion can worsen anxiety, depression and post-traumatic stress after a miscarriage. Psychological effects may continue long after bleeding and pain resolve.
Support should not assume every person experiences the loss in the same way. Some want counselling or remembrance resources; others prefer practical information and privacy.
Early pregnancy assessment clinics
The authors supported wider access to outpatient early pregnancy assessment clinics. These services can provide ultrasound, laboratory testing, diagnosis, management options and follow-up in a setting designed for pregnancy complications.
Clinics existed in parts of Canada but were not universally available and often required referral. Limited hours or geography could still leave rural and unattached patients dependent on emergency care.
Diagnosis can take time
One ultrasound or blood test may not provide a definitive answer very early in pregnancy. Clinicians may repeat measurement of the pregnancy hormone beta-hCG and ultrasound after an appropriate interval to avoid incorrectly diagnosing a viable pregnancy as a loss.
Uncertainty should be explained plainly, with written instructions stating when and where follow-up will occur and which symptoms require immediate return.
Management is a choice
Depending on clinical circumstances, options may include waiting for the body to complete the miscarriage, medication or a procedure. Each has benefits, risks and different time demands, and urgent intervention may be required when infection or heavy bleeding is present.
Patients should receive informed choice where medically safe, pain control, information about what to expect and access to Rh testing or treatment when clinically indicated under current guidance.
A better standard
Hospitals can adopt miscarriage pathways, train staff in trauma-informed communication and establish direct referral to assessment clinics. Health systems should track wait times, unplanned returns, complications and patient-reported experience.
The report did not argue that emergency departments should turn people away. It called for a system in which urgent cases remain safe in the ER while stable patients receive timely diagnosis, privacy, compassion and reliable follow-up somewhere designed to provide all four.
