how to counsel patients with miscarriage

29 Nov


–We see so many pt’s in ED who come with first trimester vaginal bleeding.

–For us, it is an easy workup, basically, our question is ectopic or not…
–…but for them, the question is: Is there anything I could have done, or that the doctors can do to save the pregnancy?

–Studies show, nothing helps:
  • not steroids
  • not pelvic rest
  • not bed rest
  • not beta HCG injections
  • not horomnes (progestogen)
  • not anticoagulation

–So, you can reassure your patients that nothing they did caused this, and there is nothing they can do to make it go on to a successful pregnancy or not. It will just do what it will do. If first trimester pregnancy does result in miscarriage, often these are chromosomal abnormalities (about 57%).

–Fortunately, if you can see an IUP on ultrasound with fetal cardiac activity, 85% of these women with early pregnancy and vaginal bleeding or abdominal pain will carry to full term.

–Heavy bleeding (more than regular menses) is associated with higher pregnancy loss, but spotting is likely to go on to a normal pregnancy.
first trimester bleeding: ddx starts with ectopic, then miscarriage (threatened or otherwise)
–spotting is better than heavy bleeding
reassure patients that there’s nothing to do, its not their fault; not much really seems to change outcome (miscarriage vs. not)
reassure patients with ultrasound: +IUP with fetal cardiac activity, 85% will carry to term
Submitted by R. Morris.  

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