What we do
TEAMM trains and supports healthcare teams to strengthen the miscarriage care they provide, in the settings where patients seek it.
01
The clinical case
Early pregnancy loss affects 10 to 20% of recognized pregnancies. It is the most common complication of pregnancy. Three options can be used to manage miscarriage. Expectant management waits for the loss to complete on its own. Medication management uses misoprostol, sometimes after mifepristone. Procedural management empties the uterus by manual aspiration.
All three options are safe for hemodynamically stable patients and the outcomes are comparable. In most situations patient preference should determine the management method.
Expectant
Effective about 81% of the time. Around 20% of patients come back for intervention.
Medication
Misoprostol alone can be used. Mifepristone before misoprostol is associated with higher completion rates than misoprostol alone.
Procedural
Performed with a handheld manual vacuum aspirator in an outpatient room. No operating room needed.
Zhang 2005 · Schreiber 2018 · ACOG Practice Bulletin, Early Pregnancy Loss
02
Where care falls short
Training programs in emergency medicine, primary care, and OB/GYN often spend little time on miscarriage. Clinical teams end up handling a common condition they were never taught much about, and expectant management becomes the default instead of one option among three. Though for some patients it is the preferred choice, others would prefer intervention when presented with the other options, which are medication or aspiration.
People seek care for early pregnancy loss wherever they can get it, whether it is in a primary care office, an urgent care, an emergency department, an OB clinic they have never been to before. Reasons for seeking care vary: bleeding that is frightening at 3AM, no established prenatal care, an OB schedule that cannot accommodate them for a week, or distance from any other option. Wherever someone first presents is usually where the decision gets made. Ensuring that the clinical team in that room can counsel on the full range of management options, rather than refer onward or ask a patient to wait, closes a gap in care.
Benson 2021 · Benson 2023
03
Our approach
TEAMM trains the whole team, not individual clinicians. A clinician who learns the procedure still cannot use it if nobody stocked the instruments or the visit cannot be booked. Nursing, scheduling, and the front desk have to be part of the change or it does not hold. Engaging support staff is the subject of TEAMM’s own published research, and part of why the trainings are built this way.
TEAMM works with sites to identify their own unique system-level resources, challenges, and goals, and helps sites work towards them by providing the training and coaching necessary to get there.
Darney 2013
04
Reach
TEAMM has trained residency programs, academic medical centers, federally qualified health centers, military hospitals, rural hospitals, and independent practices.
Recent sites include University of Mississippi, Pullman Regional Hospital, North Olympic Healthcare Network, the Upper Peninsula Health System, and La Asociación de Parteras Profesionales de Guatemala.
05
International
TEAMM has partnered with Optio in Honduras and Guatemala, and is open to forming strategic collaborations in settings outside the U.S. in the future.