Improving science and care for early pregnancy loss

Courtney Schreiber, MD, MPH, started noticing that her patients kept coming back. For a clinician who treats women in the process of losing a pregnancy, it was not a good sign. They were receiving the standard medication for miscarriage management. And it was failing. At the same time that many of these patients already were going through emotional distress at the loss of a wished-for pregnancy, their physical suffering was prolonged even after the standard treatment. Patients were returning, having gone through bleeding and discomfort to no avail, their miscarriages still not complete.

“I remember thinking, ‘This is it,’” Schreiber said. “I will no longer give a treatment that doesn’t work to a person who needs help.’”

That observation prompted Schreiber to circle back to an additional drug she had studied during her medical training. The prevailing wisdom at the time was that the second medication wasn’t necessary to treat early pregnancy loss; it wouldn’t help. Based on her initial results, Schreiber thought it deserved another look.

The research that followed not only changed U.S. and international guidelines for the medical treatment of miscarriage but led to an entirely new clinical model of care for early pregnancy loss. And it contributed to Schreiber being named this week as the 2026 winner of the BioInnovation Institute & Science Translational Medicine Prize for Innovations in Women’s Health. The award honors researchers who have made significant advances with the potential to impact women’s health across the globe. Schreiber, who is a professor and chief of family planning in Obstetrics and Gynecology at the Perelman School of Medicine at Penn, will accept the prize and present on her findings at a ceremony on April 14 at the BioInnovation Institute (BII) in Copenhagen, Denmark.

An unmet need for care in the earliest weeks of pregnancy

The patients who inspired Schreiber’s research and practice transformation weren’t originally meant to be in her care. “When I joined the faculty at Penn, my charge was to build a family planning and training program, specifically for patients with more complex needs,” she said. “But very early on, I began to recognize that we were also getting a lot of referrals for miscarriage management and for early pregnancy assessment—and that there were needs not being met with the current clinical infrastructure.”

Standard practice in the U.S. is to begin prenatal care at approximately 8 to 10 weeks gestation. Unfortunately, more than a million women in the U.S. each year will miscarry during the first trimester, often before the point when they can establish obstetric care.

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.

As the PEACE model continues to expand access to vital early pregnancy care, Schreiber and her team continue to improve the experience of patients going through loss.

For example, they observed that patients often had to wait hours on-site for blood type results to determine if their red blood cells carried a protein known as Rh factor. Pregnant women who are naturally Rh-negative are typically treated with Rh immunoglobulin to avoid having a harmful immune response in potential future pregnancies if exposed to Rh-positive fetal blood. Schreiber noted that the evidence for giving these treatments later in pregnancy and around delivery was strong. But when it came to the early weeks of pregnancy at the time of miscarriage or abortion, she and her colleagues wondered if the practice was based more on tradition than evidence.

“Seeing the amount of burden that this was placing on our patients—it may sound like a detail, but in the setting of an otherwise stressful and time-consuming care process, this was yet another layer—we started to think it was likely unnecessary.”

To research this question, they needed a way to detect how many fetal blood cells actually reached patients’ circulation in early pregnancy. “There really wasn't an existing test that could do the cell counting at the level that we needed. Luckily, because we’re at Penn where we have amazing colleagues, we were able to pair with Dr. Eline Luning Prack, MD, PhD, a pathologist who runs the flow cytometry core and had the expertise to help us create one,” Schreiber said.

What they found were nearly nonexistent levels of fetal red blood cells in the circulation of pregnant women after a loss, and later results confirmed that first-trimester miscarriage, whether by medication or procedure, cannot realistically cause Rh sensitization—making blood type testing unnecessary in early pregnancy.

Again, the findings contributed to guideline changes at home and around the world—a testament to the critical value of research responding to real, observed clinical needs.

As her work with PEACE and in translational research continues, Schreiber continues searching for patterns to refine treatment for people who need help navigating their reproductive health at the vulnerable stage of early pregnancy, and also studying underlying causes of miscarriage. “We know that about 60 percent of pregnancy losses are due to a chromosomal abnormality, and those losses need to occur, because those chromosomal problems don't result in a viable pregnancy,” Schreiber said. “But what about the other 40 percent? There’s a huge need for increased funding and investment in better understanding those other causes.”

Her continued drive to help patients at the earliest stages of pregnancy reflects her calling to make a difference with both knowledge and compassion.

“I became a doctor so that I could help people,” Schreiber said. “And the great thing about a career as a physician-scientist is that you have the joint rewards of helping the individual in front of you on one day and another day, the rewards of addressing the needs of a population as a whole by changing the trajectory of the public health through science.”