Dr. Kube: Joy of surprise pregnancy turns to miscarriage grief

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The first few hours of my shift in the emergency department had been quite busy and I finally had a chance to use the restroom, get some water and have a quick snack. As I walked back to my desk, the charge nurse asked me to immediately see my next patient because she was not doing well. I grabbed my white coat and stethoscope and went in the direction the nurse told me as several other nurses hurried into the room. 

I first saw the patient’s husband following behind the wheelchair, where his wife was hunched over. He looked pale and was clearly overcome with concern.

A triage nurse told me that Megan was having heavy vaginal bleeding and had passed out in the triage area as they were putting an IV in her arm. She quietly told me that Megan was pregnant, and she thought Megan was probably having a miscarriage.

As I walked into the room, the nurses had to lift Megan from the wheelchair into the bed because she was too weak to do it herself. I noticed that the pad she was sitting on in the wheelchair was completely saturated with blood. Her husband noticed it, too, and immediately turned away. I asked him to sit in the chair on the bed next to Megan because I was worried he might pass out.

I then went over to Megan and quickly assessed her. She was groggy but able to answer my questions. The nurses in the room quickly got Megan hooked up to our cardiac monitor and ensured she had two IVs in her arm. We started giving her fluids because her blood pressure was low, which was what had caused her to pass out.

She told me she was about seven weeks pregnant and had been having a little bit of vaginal spotting for a few days, but she had seen her OB physician, and everything had checked out OK. A few hours before she arrived in the emergency department (ED), she had started to have cramping pelvic pain and bleeding. Her bleeding rapidly increased over the next two hours, to the point where she was soaking through a pad within 30 minutes. She called her OB physician, who told her to come to the ED.

I ordered lab tests on Megan, including her blood count, pregnancy hormone level, and blood type. I went back in to check on her after she got a bag of fluid, and her blood pressure was improving. I paged her OB physician and updated her on what had happened to Megan since she arrived in the ED. She said she would be right down to evaluate Megan.

I went to check on Megan again, and her husband was sitting at her side, holding her hand. I explained to her that she was having a miscarriage, and she nodded her head, saying she knew that she was. She cried, and her husband cried. He stood up and leaned over her on the bed, and they hugged. They had recently been married and were planning on starting a family, but were surprised by this pregnancy, as they had thought they would try to get pregnant in a year or two.

Megan said she always worried about having trouble getting pregnant as her sister had problems with infertility. This made her even more surprised by her own pregnancy, and she was cautiously optimistic after she had her first OB appointment. I gave her a hug and reassured her that this miscarriage did not mean she would not be able to have a future successful pregnancy and have the family she and her husband were planning.

Megan winced as she had more abdominal cramping and passed more blood. I rechecked her blood pressure, and it had decreased from the prior reading. I asked the nurse to get another bag of IV fluids for Megan as well as a dose of pain medication. As the nurse was giving Megan the pain medications, Megan’s OB physician walked into the room.

Megan had continued to bleed since we got her in bed, and she had soaked through the pad on the bed. Her OB physician ordered Megan a medication that causes the uterus to contract, which decreases bleeding. I ordered Megan two units of blood from our blood bank, and her OB physician called the operating room (OR) to take Megan to surgery.

Within 10 minutes, the OR team came to the ED to get Megan. Her husband was trying hard to keep it together, but he started crying as they took Megan to surgery. I reassured him that taking her to surgery was necessary for Megan to stop bleeding and that she would be OK. Our social worker got him a box of Kleenex and accompanied him to the OR waiting room. Once Megan was under anesthesia, they removed all the tissue, blood, and clots from inside Megan’s uterus and were finally able to get the bleeding stopped. She did well through surgery and was reunited with her husband in the post-operative area within an hour.

Megan had to spend the night in the hospital for observation. Her repeat blood work had stabilized once the bleeding was controlled. Her cramping and pain had also stopped after surgery. Megan and her husband met with the chaplain in the hospital and grieved the loss of their pregnancy. She was able to be discharged home the following morning with plans to follow up closely with her OB physician for a recheck and to discuss her future plans for pregnancy.