Allie is a woman in her 30s and is 8 weeks pregnant. She's had severe bleeding from the vagina with abdominal cramping and so attends the hospital.
I use a speculum to examine her vagina and cervix. A clot sits at the top of the orifice. I pull it out with forceps -- and realise what looks like an egg sac is attached. It's tissue mass attached to what looks like a product of conception.
She's miscarried.
I sit her down and tell her what the likely diagnosis was. She stares at me, stunned. Her lip trembles.
"Is it something I did?"
A common question. Mums-to-be often blame themselves for miscarrying, but almost all the time it's because the foetus was never viable genetically. A mutated gene, a bad placental attachment, errors in cell division etc. Most of those spontaneously abort and women have a heavier-than-usual period, never realising they were pregnant, unless they were actively trying.
"Is there anything I can do [to save the pregnancy]?"
Another common question. Usually, no. Once the miscarriage is taking place in the first or second trimester, there is nothing that can be done. The foetus is not viable outside of the womb.
Allie asks to be allowed home for the night. Our protocol advises against that. There is a risk of heavy bleeding during a miscarriage and patients should be monitored in hospital overnight. I schedule her for an ultrasound tomorrow morning to confirm the miscarriage and ensure there isn't any products of conception remaining in her uterus (which could lead to more bleeding and infection).
She cries. Begs me to let her home for the night. "I can't deal with this alone in the hospital. I want my husband with me. Please let me go home."
I didn't want to force her to discharge against medical advice. She isn't refusing treatment. She just wanted psychological support for this very traumatic diagnosis.
I speak to my senior. Allie is allowed home leave -- something we do not routinely do at all, because if she bleeds out, it's our fault for deeming her 'fit for home leave' -- and she returns the next morning. Ultrasound confirms a miscarriage. She goes home after that.