Information Sheet for Candidates

Your next patient in your GP surgery is a 25 year old lady, Jane, who had a positive
pregnancy test 5 weeks ago but suddenly developed some mild vaginal bleeding.

Your tasks are to:

1. take a focused history
2. perform an examination and appropriate investigations
3. discuss the most likely diagnosis and management with the patient

Information Sheet for Candidates

Your next patient in your GP surgery is a 25 year old lady, Jane, who had a positive
pregnancy test 5 weeks ago but suddenly developed some mild vaginal bleeding.

Your tasks are to:

1. take a focused history
2. perform an examination and appropriate investigations
3. discuss the most likely diagnosis and management with the patient

Information Sheet for Candidates

Your next patient in your GP surgery is a 25 year old lady, Jane, who had a positive
pregnancy test 5 weeks ago but suddenly developed some mild vaginal bleeding.

Your tasks are to:

1. take a focused history
2. perform an examination and appropriate investigations
3. discuss the most likely diagnosis and management with the patient

Information Sheet for Candidates

Your next patient in your GP surgery is a 25 year old lady, Jane, who had a positive
pregnancy test 5 weeks ago but suddenly developed some mild vaginal bleeding.

Your tasks are to:

1. take a focused history
2. perform an examination and appropriate investigations
3. discuss the most likely diagnosis and management with the patient

Information Sheet for Candidates

Your next patient in your GP surgery is a 25 year old lady, Jane, who had a positive
pregnancy test 5 weeks ago but suddenly developed some mild vaginal bleeding.

Your tasks are to:

1. take a focused history
2. perform an examination and appropriate investigations
3. discuss the most likely diagnosis and management with the patient

HOPC:
This is Janes first pregnancy. She is really excited about it. Her LMP was 10 weeks ago
and 5 weeks ago a pregnancy test was positive. However, 2 days ago she noticed some
spotting which has got worse today although it is not as much bleeding as a period but
she also felt some crampy pains in her lower abdomen.
Jane is very concerned about the possibility of a miscarriage.
GYN Hx:
Menarche age 14, periods very regular, 28 day cycle, usually for 5-6 days, no pains, LMP
10 weeks ago.
No pregnancies.
SHx:
Married secretary. They purchased a small house last year and are looking forward to
starting a family. Usually drinks little alcohol and has given it up since knowing that she
is pregnant, non smoker, NKA
Examination:
Jane looks quite worried but her general appearance and examination are unremarkable
except for very mild suprapubic tenderness.
PV: slight vaginal bleeding, os closed, bimanual examination reveals the size of a 10
week pregnant uterus, no adnexal mass or tenderness.
Investigations:
FBE,
Serial Beta-HCG (should rise!)
Blood group and Rh
U/S: shows a normally sized amniotic sac with a viable fetus with normal cardiac
activity which is c/w a threatened miscarriage!
DIAGNOSIS: THREATENED MISCARRIAGE (ABORTION)
MANAGEMENT:
Reassurance and rest in bed if the patient feels that helps.
Explain possible outcomes, i.e. in 90% of spontaneous abortions the fetus is either
absent or grossly malformed, whilst her U/S shows a normal fetus and her chance
of successful pregnancy is about 90%!!!!
COMPLICATIONS:
Progression to complete miscarriage
Haemorrhage
Rh sensitisation