Massachusetts Medical Society: Evidence-based Medication Management of Early Pregnancy Loss

Evidence-based Medication Management of Early Pregnancy Loss

Evidence-based Medication Management of Early Pregnancy Loss

Course Overview
Approximately 80% of all cases of pregnancy loss occur within the first trimester, and more than 1 million people in the US annually experience early pregnancy loss (EPL). This activity presents the most up-to-date scientific evidence, detailed steps for medical management of EPL, and REMS (Risk Evaluation & Mitigation Strategy) protocols for mifepristone administration.  At the end of this evidence-based review and patient case, you'll be equipped with the knowledge and skills to offer EPL medical management in most clinical scenarios.

Rapidly developing state and federal policy decisions regarding the use of mifepristone continue to create confusion for clinicians about the legal permissibility of the drug.  On Friday, April 7, 2023, a federal district court in Texas issued a preliminary ruling with a nationwide impact, staying the US Food and 
Drug Administration (FDA)’s 2000 approval of mifepristone. That ruling currently (April 13, 2013) has no legal effect because the US Circuit Court of Appeals for the 5th Circuit stayed the decision. A conflicting ruling was concurrently issued out of a federal district court in Washington state on April 7th, ordering the FDA to make no changes to the availability of mifepristone in certain states.  

As of April 13, 2023, mifepristone continues to be an FDA approved drug. Please consult with local counsel to determine if there are any restrictions on the prescribing, dispensing, or administering of mifepristone in your state. The legal challenges do not necessarily change the medical efficacy or evidence base for the medication management of early pregnancy loss.  However, if mifepristone is restricted, clinicians may be required to provide medication management of early pregnancy failure using misoprostol alone. 

The content to this course has been reviewed and revised to reflect the current state of legality around use of mifepristone in Massachusetts. The course will continue to be monitored and updated as policy decisions are made.


Rebekah Rollston

Rebekah Rollston, MD, MPH
Family Medicine Physician, Cambridge Health Alliance Instructor in Medicine, Harvard Medical School, Faculty Affiliate, Harvard Medical School Center for Primary Care

Dr. Rollston is a Family Medicine Physician at Cambridge Health Alliance, Instructor in Medicine at Harvard Medical School, Affiliate Editor-in-Chief of the Harvard Primary Care Blog, and Founder & Executive Director of Doctors For A Healthy US, LLC. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Her professional interests focus on social determinants of health & health equity, gender-based violence, sexual & reproductive health, addiction medicine, rural health, homelessness & supportive housing, and immigrant health. She has published on these topics in The Lancet, American Journal of Health Promotion, and Medical Care. And further, Dr. Rollston is currently a Visiting Scholar in the Northeastern University Women, Gender, and Sexuality Studies Program (AY 2020-2021), where she’s studying the intersection of COVID-19, population health outcomes, and women’s leadership styles internationally. Dr. Rollston is an active member of the Harvard Joint Committee on the Status of Women, Massachusetts Medical Society Committee on Public Health, and also an External Affiliate of the RTI Global Gender Center.


Lauren Sobel, DO, MPH
Complex Family Planning Fellow, Department of Obstetrics & Gynecology, Brigham & Women’s Hospital/ Harvard Medical School

Dr. Sobel earned her doctor of osteopathy (DO) degree and Masters in Public Health (MPH) at Touro University in Vallejo, California. She then moved to Boston where she completed her Obstetrics & Gynecology residency at Boston Medical Center. She is currently a Complex Family Planning fellow at Brigham and Women's Hospital/Harvard Medical School. Her professional interests focus on the labor and delivery and contraception experience of women with opioid use disorder and the intersection of intimate partner violence and trauma-informed abortion care. 

Intended Audience
The target audience for this educational activity is primary care, emergency, and OB/GYN providers, as well as any other health professionals providing reproductive healthcare..

Course Objectives

  • Define Early Pregnancy Loss (EPL)
  • Review evidence-based EPL diagnostic criteria
  • Compare evidence-based EPL medical management regimens 
  • Identify evidence-based EPL follow-up options

Course Fees
Massachusetts Medical Society (MMS) Physician Member: $20.00
MMS Resident/Student Member: Free
Non-Member Physician: $45.00
Non-Members Resident/Student: $10.00
Allied Health Professional/Other: $16.00

Format & Estimated Time to Complete: Video, 1 hour

Accreditation Statement
Accreditation and Credit Information
The Massachusetts Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

AMA Credit Designation Statement
The Massachusetts Medical Society designates this internet enduring material for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity meets the criteria for the Massachusetts Board of Registration in Medicine for risk management study.

MOC Approval Statement
Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification Directory, this activity has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

 Family Medicine

National Commission on Certification of Physicians Assistant (NCCPA)
Physician Assistants may claim a maximum of 1.00 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credits™ from organizations accredited by ACCME or a recognized state medical society.

Exam/Assessment:  A score of 70% or higher is required to receive AMA PRA Category 1 Credits™

Activity Term
Original Release Date: January 8, 2021
Review Date (s): March 1, 2023
Termination Date: January 8, 2024

Course Developers, Reviewers & Web Producer:
Kari P. Braaten, MD, MPH, Medical Director, Fish Center for Women’s Health, Brigham and Women’s Hospital; Associate Fellowship Director, Fellowship in Complex Family Planning; Assistant Professor of Obstetrics, Gynecology and Reproductive Medicine, Harvard Medical School
Alexandra Spadola, MD, Medical Director, Labor & Delivery, Visiting Associate Professor, Department of Obstetrics & Gynecology, Tufts Medical Center & Tufts University School of Medicine
Danna G. Muir, MBA, Director, Accreditation & Recognition, NEJM Group Education  
Jane E. Gagne, Manager, Accreditation and Education Compliance, NEJM Group Education 
Sara G. Shields, MD, MS, FAAFP, Family Medicine with Obstetrics, UMass Memorial Health Care and Professor, University of Massachusetts Medical School 
Thelma J. Tatten, Web Content Production Specialist, NEJM Group Education

System Requirements

Windows, XP, Vista, 7, 8
Mac OSX 10.6 higher

Most modern browsers including:  
Firefox 18.0+
Chrome 26+
Safari 5+
Flash player is required for some Online CME courses.

iOS devices beginning with OS version 5 or higher (includes, iPhone, ipad and iTouch devices)
Android devices including tablets and phones.
Windows RT and tablets on Windows 8 are also supported.


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