In her winning essay for the BII & Science Translational Medicine prize, Schreiber describes a typical case: “Teresa, a teacher and a mother of a 6-year-old, was excited to welcome a sibling for her son after seeing a positive home pregnancy test. Then, while at work, she started to bleed. She called her previous obstetrician, but that office had no availability, so she was advised to go to the emergency department. Teresa arranged for childcare and then waited in the emergency department for five hours before she was evaluated. Finally, an ultrasound confirmed Teresa’s early pregnancy loss diagnosis. When the results of her blood type came back, she was discharged for outpatient management of her nonviable pregnancy. Because she was too early in pregnancy to have established prenatal care, she struggled to obtain follow-up care and ultimately came to our clinic.”
Then, in the midst of journeys like these, patients like Teresa would finally receive a prescription for medication to complete the miscarriage after getting an outpatient appointment. When that didn’t always ease their suffering in the way Schreiber hoped, it prompted her research on better medication protocols. And along the way, Schreiber also reimagined the way patients could get the care they need.
Minding the gaps, from research to models of care
Schreiber sought and received funding from the National Institutes of Health for a randomized trial to test her theory that combining two medications, mifepristone and misoprostol, would help patients complete their miscarriages faster and with less need for surgical interventions compared to only one drug. The findings not only bore out her prediction, but also prompted changes to U.S. and international guidelines to recommend mifepristone be added as a premedication when available.
Meanwhile, the process of launching that trial became an unexpected catalyst of transformational changes in how patients like Teresa get access to convenient, compassionate care. It started with a question of recruitment for the NIH-funded trial: How to find 300 patients interested in participating in a research study in the midst of a potentially devastating loss. Schreiber and her team began intentionally working to welcome even more women with early pregnancy complications into the clinic. They soon saw unexpected commonalities in the struggles of patients at this early, vulnerable stage of pregnancy, whether they were navigating a spontaneous miscarriage or other challenges.
With support from an accelerator grant from the Penn Center for Health Care Transformation and Innovation from 2017-2019, Scheiber collaborated across Penn departments and founded the first-of-its-kind Pregnancy Early Access Center (PEACE) at the Perelman School of Medicine. PEACE is a clinic that bridges the eight-week gap in standard prenatal care and improves the care pathways for women experiencing early loss.
“Access to home pregnancy testing means people now often know that they’re pregnant at a very early stage, and their hopes, expectations, and fears set in early on,” Schreiber said. “The lack of attention to this area has left patients and their loved ones feeling stigma, shame, and self-blame, which is highly counter-productive and adds insult to injury.”
Having an infrastructure for early pregnancy care saves patients time, money, and unnecessary additional suffering. And it also gives physicians the volume of cases to notice patterns and places where treatment can continue to be improved.
Since its founding, PEACE has become the model for nearly 80 new early pregnancy clinics that have opened across the country, giving many more patients like Teresa a place to be seen and to heal.