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PATIENT COMMUNICATION STATION

AMELIA HAS HAD A MISCARRIAGE; CAN YOU PLEASE DISCUSS THIS WITH HER AND ANSWER ANY QUESTIONS SHE MAY HAVE

INVESTIGATION RESULTS  Amelia known to be 18/40 weeks pregnant has presented to GAU with mild PV bleeding  On TV Ultrasound Scan: • No intrauterine gestational sac and no ovarian or fallopian mass • Heterogenous shadows within the endometrial cavity of mixed echogenicity with retained products of conception.

• What is the diagnosis? • Incomplete miscarriage Please explain this to Amelia and answer any questions that she may have

APPROACH  Greet, introduce, check details

 Check understanding of situation from her perspective  Sign post, warning shots, silences/pause to be broken by patient  Rx – 3 types of management (next slide)

APPROACH TO MANAGEMENT  Conservative:  • • 

Most can resolve on their own. Severe tummy pain/cramps, heavy bleeding and can be emotionally difficult. First-line and involves waiting for 7-14 days for the miscarriage to complete spontaneously If expectant management is unsuccessful then medical or surgical management may be offered Some women find all of this very upsetting so can offer counselling

 Medical:

 Vaginal misoprostol • Prostaglandin analogue, binds to myometrial cells to cause strong myometrial contractions leading to the expulsion of tissue • Advise them to contact the doctor if the bleeding hasn't started in 24 hours. • Should be given with antiemetics and pain relief • If rhesus D –ve and no sensitisation then give anti-D

• Surgical: • • • •

'Undergoing a surgical procedure under local or general anaesthetic' The two main options are vacuum aspiration (suction curettage) or surgical management in theatre Vacuum aspiration is done under local anaesthetic as an outpatient Surgical management is done in theatre under general anaesthetic. This was previously referred to as 'Evacuation of retained products of conception'

QUESTIONS  What are the causes of recurrent miscarriages?      

Antiphospholipid syndrome Endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders. Polycystic ovarian syndrome Uterine abnormality: e.g. uterine septum Parental chromosomal abnormalities Smoking...