MM-TI

Miscarriage Management

Training Initiative

Miscarriage Management Case Studies

Instructions:
1) Review the case study that is assigned to your group. You will have 10 minutes.


2) Discuss the following questions:
a) What are the potential red flags that need to be addressed?
b) What are the values, beliefs or biases that may impact this patient’s visit?
c) What tools, skills and/or resources will be important for you to have in order to feel

confident?


3) Be prepared to present the case study to the large group.


Case Study #1: Suzanne
Suzanne, 32 yr. old, G2P1, gestation 7w5d, married
Suzanne is in clinic alone to have a procedure for a miscarriage. She will not have any medication since she is driving herself home nor does she want to call anyone. Suzanne is relieved that she is miscarrying since she and her husband are very short of money and she just recently lost her job. She says that she has no questions and just wants to get on with it.
Suzanne shares with you that she never told her husband that she was pregnant. She does not plan on telling him about the miscarriage since that would make him really sad and she wants to protect him from those feelings.
1. What are the potential red flags that need to be addressed

2. What are the values, beliefs or biases that may impact this patient's visit?
3. What tools, skills and/or resources will important for you to have?

Case Study #2: Jill
Jill, 28 yr. old, G5PO, gestation 9w2d, married
Jill is very quiet and weeping softly when you begin to go over instructions about the procedure for her miscarriage.
She tells you that this is her 5th miscarriage and she is feeling hopeless about ever having a child. Her friends have suggested that she and her husband adopt a baby, but she says that they want to have their own child. Her doctor wants her to attend a fertility clinic, but they cannot afford it and their current insurance will not cover any of it. She had gotten a little further along this time and thought that she actually might carry this one to term. Her husband is so sad and disappointed that he could not be with her in clinic.
1. What are the potential red flags that need to be addressed

2. What are the values, beliefs or biases that may impact this patient's visit?
3. What tools, skills and/or resources will be important for you to have?

Case Study #3: Kim
Kim, 35 yr old, G3P2, gestation 7w2d, recently divorced, living alone
Kim's sister will be with her during the appointment and she tells you that she could not have taken care of more children, so it is probably for the best that she is miscarrying. This pregnancy is by her ex-husband who does not know about it and she wonders if she should tell him. Kim thinks that he might not care, and that will make her even more upset. She also asks about whether she should tell the other children about their lost brother or sister. She had wanted her sister to come back with her but the sister faints easily. Kim is not sure that she can make it through this alone.

1. What are the potential red flags that need to be addressed?
2. What are the values, beliefs or biases that may impact this patient's visit?
3. What tools, skills and/or resources will be important for you to have?

Case Study #4: Annie
Annie, 19 yr old, single, first pregnancy, gestation: 6w2d, college sophomore. She was referred to your clinic after the ultrasound shows that she was miscarrying. She is in clinic alone and plans not to call anyone to be with her.
Annie attended a private Catholic High School and is starting her sophomore year in college. She was very surprised to learn she was pregnant and tells you that she probably got pregnant while home during summer vacation when she was with her old boyfriend.
1. What are the potential red flags that need to be addressed?
2. What are the values, beliefs or biases that may impact this patient's visit?
3. What tools, skills and/or resources will be important for the support person to have?

Miscarriage Management-Training Initiative Johnson-May, VanDerhei, Wallace