1. Section Editor(s): Limbo, Rana PhD, RN, CPLC, FAAN

Article Content

The language of miscarriage should be respectful, oriented to the meaning the miscarriage has for the woman experiencing it, and consistent across all persons providing care. When one considers the enormity of early pregnancy loss and its effect on up to 1 million women and their families each year in the United States, research, quality initiatives, relationship-based clinical practice, and precise language are imperatives.


Merrigan's article on standards related specifically to care in the emergency department (ED) highlights education for nurses and other care providers for women experiencing miscarriage. The ED is the first point of care for many women with symptoms of miscarriage. Whether they know from a previous ultrasonogram that their pregnancy will end or they come to the ED with symptoms of bleeding and/or cramping, they expect that those caring for them understand what to do, what to say, and how to guide them through what may be a terrifying time. Education is at the center of preparing caregivers to be present in the way each woman-and perhaps one or more of her family members-needs.


Catlin reports on care of women experiencing all types of perinatal loss in the ED by describing the findings of research conducted with experts in the field using the Delphi technique. The outcomes are published as Interdisciplinary Guidelines for Care of Women Presenting to the Emergency Department with Pregnancy Loss. The guidelines contain numerous suggestions for those providing care in the ED. I encourage all who work in outpatient settings (e.g., the ED, clinics, same-day surgery, pathology laboratory) or inpatient areas (e.g., childbearing units, pre- and postoperative centers) to read the statement.


Levang and colleagues encourage all hospitals and clinics to create a process for disposition that entails no comingling of remains after miscarriage, ectopic pregnancy, or molar pregnancy with other human tissue. They summarize the laws in those states that have legally addressed respectful disposition and provide ideas for burial, a remembrance service, and containers for the remains, whether through group burial or family-selected final disposition (funeral director, private burial site).


Walter and Alvarado summarize basic clinical information to answer questions that nurses are often asked and for which they want to be prepared. One key point they make is that in recent years, three prestigious physician organizations (the American College of Obstetricians and Gynecologists, the Royal College for Obstetricians and Gynaecologists, and the American Society for Reproductive Medicine) have replaced the term spontaneous abortion with miscarriage on their Web sites and in their literature. This dramatic shift in terminology reminds me of a woman I cared for many years ago who, after she happened to see her discharge papers lying next to the unit secretary, told me "Everything I saw was in black and white except for my diagnosis: 'Spontaneous abortion, complete.' That stood out in neon. I did not have an abortion."


I hope you will enjoy reading all of these articles and will learn a few pearls about how to care for women experiencing an early pregnancy loss. It is very likely that the woman will forever remember the nursing care she received. Often there is very little clinical care we can offer that can affect the physical outcome when a woman presents with signs of a miscarriage; however, the other aspects of care discussed in detail in these four articles are vital to her perception of the event and recovery.