In a homeless patient with a spontaneous abortion, what is the next best step in management?

• A. Suction curettage
• B. Expectant management
• C. Medical management with misoprostol
• D. Dilation and curettage

Answer: (A)

In early pregnancy miscarriage management, the priority is to remove all products of conception and prevent ongoing bleeding or infection. When a patient’s social situation makes reliable follow-up unlikely—such as homelessness—a definitive, one-visit procedure is preferred to avoid the risk of incomplete evacuation or delayed complications.

Suction curettage uses vacuum aspiration to evacuate the uterus quickly and effectively in the first trimester. It provides rapid resolution in a single encounter, is highly successful, and can be done in an outpatient setting with minimal need for prolonged follow-up. This makes it especially suitable for someone who may not be able to return for later care.

Medical management with misoprostol can be effective but often requires several days and follow-up to ensure completion; failure or incomplete expulsion may necessitate surgical intervention anyway. Expectant management can be unpredictable and may prolong risk of heavy bleeding or infection while awaiting spontaneous completion. Dilation and curettage is a valid surgical option, but suction curettage is typically favored in early pregnancy for a quicker, single-session evacuation.

Thus, suction curettage is the most appropriate next step in this context.