The reason I give them a picture of something they is nothing but a yolk sac and a fetal pole... its the first picture they see of the fetus and there really isn't anything else we do that makes a difference in these patients once we exclude ectopic. It's just mainly managing the patient's fear and anxiety about the whole thing and setting expectations (so they don't keep coming back for more spotting every other day). It takes a terribly stressful situation for the mother (100% of which think they are miscarrying) and gives them something to hold on to (proof the haven't miscarried yet).
I've realized a long time ago, for all 1st trimester bleeding patients that aren't ectopics, we make zero difference in their care. When we do the US, check labs, etc. None of it affects the outcome. We can't stop a miscarriage if its going to happen. So because we can't actually do anything for the patient, I figured at the very least I can give them good solid information and relieve their suffering. Because make no mistake, these people are all suffering; they are anxious and paranoid what they hope to be their child is dying, they feel helpless, and have no idea what to do. Taking the time out of the shift to spend 2 minutes is worth it, it makes a big difference in the patient's perception of their care they received even though we really didn't do anything for them but listened to their fear and gave them expectations of what could happen and how likely it is to occur.
I give the same talk over and over in these patients once I identify an IUP with a heart beat. This is usually what I say:
"Miscarriage is unfortunately very common and not preventable. Anywhere from 1/4 to 1/2 of all pregnancies end in miscarriage. Seeing the fetus on the ultrasound with a heart beat is a really good sign, once you see that in a mom with bleeding in the first trimester, the chance they are going to miscarry goes down, but still is like a 10-15% chance at that point (I've seen a study that actually quotes 8% once you have a heart beat in an IUP, but I overestimate a little). If it happens, it was unavoidable and nothing you did wrong. The good thing is, in your case we know the pregnancy appears to be in the right place at this time and is alive at this point all of which is a positive sign to be hopeful about. We call this a threatened miscarriage, but don't be alarmed by the name. It just means this could be an early sign of a miscarriage, but at this point we know the odds are at least in your favor. You may continue to have spotting but need to come back for heavy bleeding more than two pads/hr and in the meantime need to call your OB/GYN tomorrow to schedule followup so they can reassess the pregnancy to make sure everything is hopefully progressing ok. I know I gave you a lot of information, what questions do you have for me?"
