Access to Early Pregnancy Assessment Clinics and Guideline-Recommended Investigations for Recurrent Pregnancy Loss in Ontario.

Abstract

Early pregnancy assessment clinics (EPACs) are key in managing early pregnancy complications, yet access across Ontario remains limited. Little is also known regarding EPACs' integration of recurrent pregnancy loss (RPL) care, impacting up to 5% of patients. We surveyed Ontario obstetrics and gynaecology chiefs (May-October 2025, 33 responses, 61% response rate), and found 50% had EPACs and 15% had RPL protocols. Access to RPL investigations varied: gynaecologic ultrasound (89%), antiphospholipid antibody testing (85%), products of conception testing (54%), parental karyotyping (39%), and 3D ultrasound/sonohysterography (31%). We advocate for greater EPACs access, and integrated RPL protocols to improve patient care.