by Andrea Suozzo, Kavitha Surana and Lizzie Presser

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Even though about a million women a year experience a miscarriage, there is little research on complications related to pregnancy loss in the first trimester, when most miscarriages happen. The need to explore this phase is urgent, experts told ProPublica, given the way state abortion bans have disrupted maternal health care.

Although most early miscarriages resolve without complications, patients with heavy bleeding can hemorrhage if they don’t get appropriate treatment — which includes a procedure called dilation and curettage, or D&C, that is now tangled up in legislation that bans abortion. As women recounted being left to lose dangerous amounts of blood, and ProPublica told the story of a mother who died in a Houston hospital while seeking miscarriage care, reporters searched for a way to gain a broader understanding of what was happening in the state.

We consulted dozens of researchers and clinicians to develop our methodology and understand how to look at early miscarriage outcomes in the emergency department.

Our latest analysis, of hospital discharge data from Texas, found that after the state made performing abortions a felony in August 2022, the number of blood transfusions during emergency room visits for first-trimester miscarriage shot up by 54%.

The number of emergency room visits during first-trimester miscarriage also rose by 25%, a sign that women may be returning to hospitals in worse condition after being sent home, more than a dozen experts told ProPublica.

Experts say the spike is a troubling indicator of delays in care.

The most effective way to prevent severe blood loss during miscarriages, experts said, is a D&C, which uses suction to remove remaining tissue, allowing the uterus to close. The procedure is also used to terminate pregnancies.

Dr. Elliott Main, an expert on maternal hemorrhage and the former medical director for the California Maternal Quality Care Collaborative, said the increase in transfusions suggested to him that doctors working under abortion bans are now delaying those interventions for miscarrying patients for longer — “until they’re really bleeding.”

These findings........

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