Quality Standard Details
Early Pregnancy Complications and Loss: Care for Adults in All Settings
- Publication Date
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2019-July-01
- Status
- Published
- Topic Area
- Fertility, Pregnancy and Childbirth
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Early pregnancy complications and loss affect many people in Ontario. It is estimated that approximately 20% of pregnancies end in miscarriage, and nearly 80% of miscarriages occur in the first trimester. The emotional and psychological impacts of early pregnancy loss can be serious. For some people, the emotional distress can result in clinical depression, post-traumatic stress disorder, and/or anxiety.
Ontario families experiencing early pregnancy loss have reported a lack of kindness and respect from health care professionals, that they felt less supported, and that they experienced more stigma at the time of their loss, compared with people whose loss occurred later in the pregnancy. They were also less likely to be offered a follow-up appointment and get the support they needed, highlighting the need for significant system improvement.
This quality standard addresses care for people experiencing complications, such as pain and vaginal bleeding, and/or the loss of their pregnancy in the first 13 weeks. It applies to all health care settings and includes diagnosis, follow-up, and management of physical and emotional aspects of care for early pregnancy complications or loss.
This standard includes pregnancy of unknown location (where a person has a positive pregnancy test but no pregnancy is visible in an ultrasound), tubal ectopic pregnancy (a potentially dangerous condition in which the embryo implants in a fallopian tube), and intrauterine pregnancy loss (missed, complete, or incomplete miscarriage).
Quality Standard in Brief
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Quality Statement 1: Comprehensive Assessment
People with signs or symptoms of early pregnancy complications receive a comprehensive assessment that includes a transvaginal ultrasound and serum beta-hCG measurement.
Quality Statement 2: Early Pregnancy Assessment Services
People experiencing early pregnancy complications and loss have access to early pregnancy assessment services.
Quality Statement 3: Pregnancy of Unknown Location
People with a pregnancy of unknown location (not visible in the uterus or adnexa, on ultrasound) receive two serial serum beta-hCG measurements taken 48 hours apart. They are followed until a final diagnosis is made or until beta-hCG returns to zero.
Quality Statement 4: Diagnosis of Intrauterine Early Pregnancy Loss
Pregnant people who experience intrauterine early pregnancy loss receive this diagnosis as quickly as possible based on transvaginal ultrasound. While waiting to learn whether or not the pregnancy is viable, they receive information on who to contact, where to go, and how long it should take to receive a diagnosis. A diagnosis of early pregnancy loss is also communicated to the person’s primary or other relevant care providers.
Quality Statement 5: Management Options for Intrauterine Early Pregnancy Loss
People with intrauterine early pregnancy loss receive information on all potential management options (expectant, medical, and surgical) and are supported in making an informed decision on the most appropriate management approach for them, based on their diagnosis, clinical situation, values, and preferences.
Quality Statement 6: Management Options for Tubal Ectopic Pregnancy
People with a confirmed tubal ectopic pregnancy receive information on all potential management options (expectant, medical, and surgical) and are supported to make an informed decision about their care. They have access to their preferred management option. Health care professionals closely monitor signs and symptoms and arrange appropriate access to follow-up care.
Quality Statement 7: Compassionate Care
People and families experiencing early pregnancy complications and/or loss are treated with dignity and respect, and receive support in a sensitive manner, taking into account their individual circumstances and emotional responses, no matter where they receive their care.
Quality Statement 8: Psychosocial and Peer Supports
People who experience an early pregnancy loss and their families are offered information about psychosocial and peer support services and organizations.
Supporting Documents
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Patient guide for this quality standard
Know what to ask for in your care
Placemat for this quality standard
A quick-reference resource for clinicians that summarizes the quality standard and includes links to helpful resources and tools
Quality improvement tools and resources for health care professionals, including an action plan template
Supplementary information to support the data collection and measurement process
Additional Resources
If you would like to receive these resources, please send us a message using our contact form:
- Case for improvement (slide deck)
Share why this standard was created and the data behind it, to get the support you need to put it into practice - Technical specifications
See the technical specifications for the indicators within the quality standard - Tools to support patient care
- Summary of the public feedback we received
- Case for improvement (slide deck)
Last Updated: February 24, 2026
