You are working in a GP practice. Your next patient is 25 year old woman who had 3 miscarriages before at 8 – 10 weeks of gestation. She came to you previously and you organized some investigations for her. Today she came for the investigation results. Tasks ask for the investigation results from the examiner (you will be given only what you have asked for) Manage the patient. RP Doctor, you did some blood test last time. Meyes, we did. I’ll explain them to you in a minute. (I turned to the examiner) Can I get investigation findings please? Examiner What do you want to know? Me Can I get thrombophilic screening. TORCH screening, Lupus screening, Karyotyping, Chromosomal analysis, FBC, blood group and antibodies, previous AN screening, Ultrasound (all the results are normal) Me I’ve got a good news for you. All the test results turned out to be normal. RP then why am I getting miscarriages, it has been 3 times already. (RP looks desperate) Me I can understand that it must have been a very painful experience for you. Since we cannot find any obvious cause at this stage, I would like to refer you and your partner to the genetic counselor and the obstetrician who will offer you further investigations. RP one of my friends had a stitch to prevent the miscarriage. Me Cervical stitch is for those who has late pregnancy miscarriage on background of cervical incompetence. In your case, most likely due to chromosomal abnormalities since it is early pregnancy miscarriage. RP Am I going to have another miscarriage? Me given your history of recurrent miscarriage, you are at a higher risk of getting another miscarriage than the general populations. But I would like to reassure that there are advanced technique that we can offer you. Btw, are you coping well? How about your partner? RP not really Me would you like to share your thoughts and feeling? I can arrange a psychologist counseling for you. RP Thank you, doctor AMC feedback recurrent miscarriage (passed)
Posted on: Fri, 28 Mar 2014 00:22:46 +0000