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The Language of First-Trimester Nonviable Pregnancy

Patient-Reported Preferences and Clarity

Clement, Elizabeth G., MD; Horvath, Sarah, MD, MSHP; McAllister, Arden, MPH; Koelper, Nathanael C., MPH; Sammel, Mary D., ScD; Schreiber, Courtney A., MD, MPH

doi: 10.1097/AOG.0000000000002997
Obstetrics: Original Research: PDF Only

OBJECTIVE: To document the terminology patients hear during the treatment course for a nonviable pregnancy and to ask patients their perceived clarity and preference of terminology to identify a patient-centered lexicon.

METHODS: We performed a preplanned substudy survey of English-speaking participants in New York, Pennsylvania, and California at the time of enrollment in a randomized multisite trial of medical management of first-trimester early pregnancy loss. The six-item survey, administered on paper or an electronic tablet, was developed and piloted for internal and external validity. We used a visual analog scale and quantified tests of associations between participant characteristics and survey responses using risk ratios.

RESULTS: We approached 155 English-speaking participants in the parent study, of whom 145 (93.5%) participated. In the process of receiving their diagnosis from a clinician, participants reported hearing the terms “miscarriage” (n=109 [75.2%]) and “early pregnancy loss” (n=73 [50.3%]) more than “early pregnancy failure” (n=31 [21.3%]) and “spontaneous abortion” (n=21 [14.4%]). The majority selected “miscarriage” (n=79 [54.5%]) followed by “early pregnancy loss” (n=49 [33.8%]) as their preferred term. In multivariable models controlling for study site, ethnicity, race, history of induced abortion, and whether the current pregnancy was planned, women indicated that “spontaneous abortion” and “early pregnancy failure” were significantly less clear than “early pregnancy loss” (53/145, adjusted risk ratio 0.12, 95% CI 0.07–0.19 and 92/145, adjusted risk ratio 0.38, 95% CI 0.24–0.61, respectively, as compared with 118/145 for “early pregnancy loss”). “Miscarriage” scored similarly to “early pregnancy loss” in clarity (119/145, adjusted risk ratio 1.05, 95% CI 0.62–1.77).

CONCLUSION: The terminology used to communicate “nonviable pregnancy in the first trimester” is highly variable. In this cohort of women, most preferred the term “miscarriage” and classified both “miscarriage” and “early pregnancy loss” as clear labels for a nonviable pregnancy. Health care providers can use these terms to enhance patient–clinician communication.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02012491.

Miscarriage and early pregnancy loss are the clearest terms when diagnosing and managing early pregnancy demise and are preferred over spontaneous abortion and early pregnancy failure.

Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, the Division of Family Planning, and the Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Corresponding author: Elizabeth G. Clement, MD, University of Pennsylvania, Department of Obstetrics and Gynecology, 3701 Market Street, 3rd Floor, Philadelphia, PA 19104; email: Elizabeth.clement@uphs.upenn.edu.

Supported by National Institutes of Health R01-HD0719-20 and the Society of Family Planning Research Fund Midcareer Mentor Award (Courtney A. Schreiber).

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the North American Forum on Family Planning, October 14–16, 2017, Atlanta, Georgia.

Each author has confirmed compliance with the journal’s requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B203.

Received June 22, 2018

Received in revised form September 18, 2018

Accepted October 04, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.