how to counsel patients with miscarriage

WHY IT MATTERS:

--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?
 

KEY POINTS:

--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.

10-SECOND RECAP:

--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.  

Reference(s): fetal cardiac activity, ultrasound, aspirin or anticoagulants, progestogen, bed rest, first trimester bleeding, threatened miscarriage, chromosome abnormalities, picture