Family Planning/Abortion Nursing Coordination in UW Health 

• Family Planning/Abortion Nursing Coordination is now available through the Early Pregnancy Assessment Clinic (EPAC). 

• Providers can refer patients desiring abortion care, in need of medically indicated abortion or pregnancy options counseling.

• EPAC team facilitates access to care within UW Health and assists in referrals outside UW Health. • Pregnant patients can get guidance and comprehensive support and can self refer. 

• Check the Reproductive Hub on U-Connect (must log in with UW log in) for this information Contact information: Providers only: 608-282-8275 (not for patients) General public: 608-287-2830; UWHealth.org 

Miscarriage Management Options

Management of EPL includes 3 possible options: 

1. Expectant Management
   (Patient Handout English, Patient Handout Spanish) 

2. Medication Management 

   1. Misoprostol alone 

   2. Mifepristone + Misoprostol (see below)

(Patient Handout English, Patient Handout Spanish) 

3. Surgical Management   

   1. Manual Vaccuum Aspiration (MVA) 

   2. D&C 

**UW Health OB/GYN has an Early Pregnancy Assessment Clinic on Wednesdays, staffed by Drs. Eliza Bennett, Abigail Cutler, and Laura Jacques. This clinic also houses the Early Pregnancy Loss Tissue Disposition Program, PP included for more information.  

Mifepristone for early pregnancy loss

Summary of Steps:

1. Labs - ensure HCG, H/H, ABO/Rh have all been obtained 

2. Counseling - review with the patient the process of M+M meds using the above patient handouts and the consent forms 

3. Consent - sign the UW consent form (English Consent, Spanish Consent) AND the distributor specific, GenBioPro or Danco, consent form (both attached) 

4. Mifepristone - one tablet of mifepristone 200 mg should be dispensed to the patient while in the office. This is held in our locked medication box in the med room.

5. Misoprostol - prescribe four tablets of 200 mcg misoprostol (800 mcg total) for the patient to use vaginally or buccally 24 hours following mifepristone. *Use the "Medical Management of Early Pregnancy Loss" SmartSet in Epic *  

6. Supportive meds - prescribe NSAIDS and anti-emetics to the patient  *Use the "Medical Management of Early Pregnancy Loss" SmartSet in Epic * 

7. Patient instructions - give patient the corresponding handout (accessible through above links or in the Epic SmartSet) 

8. Documentation - Jess Dalby has the following note template that can be used to appropriately document the visit. Use: ".MISCARRIAGEMIFE" [1014872]. Ensure the NDC and lot number from each package of Mifeprex are recorded in the patient’s record. 

9. Follow up - patient should schedule follow-up to ensure a complete passage of tissue in one of two ways: 1) repeat quantitative serum HCG level following passage of tissue (a drop of 80% by 7 days) or 2) a transvaginal ultrasound with absence of sac. 

10. Bleeding concerns - https://www.reproductiveaccess.org/wp-content/uploads/2016/07/phone-triage-for-miscarriage-management-2016-06-20.pdf  

Legal Notes: 

Per the UW Health Pharmacy Manager, Mifepristone is a part of the FDA risk evaluation and mitigation strategy (REMS) program. Dr. Jessica Dalby holds the Provider Certification for dispensing mifepristone across all UW family medicine residency clinics. Therefore, she is listed as the supervising physician for all mifepristone dispenses; however, it does not mean she needs to be present for dispensing the medication at our clinic. We can dispense mifepristone when all of the above steps have been completed.