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Pregnancy Loss in the ED

Spontaneous loss of a pregnancy can be both a physically and emotionally painful experience. Dr. Corinne Rezentes visits the blog today to share her own experience and how this will impact her patient care as she moves into her career as a physician.

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Wednesday afternoon, the middle of week 12, was the first day of spotting. There was some mild pelvic discomfort but nothing else. I decided to take it easy and spent most of the day on the couch. I think I had a suspicion, but I definitely wasn’t giving it any thought let alone voicing it. Thursday, the spotting continued, and all of it was dark brown/pink except for one time that evening, in which it was bright red. Friday, I continued to have some very mild and intermittent spotting, but I spent most the day convincing myself it was normal by googling and reading way too many articles.

Saturday morning. The last day of week 12 and the first trimester. My husband and I woke up, and we both started to make breakfast but I had cramps that were painful enough that I needed to sit down. While on the couch I asked him what he wanted to do, and he said, “Go to the ER.” I knew it was what we needed to do for both peace of mind and to make sure the cramping was nothing more serious. So we got up and drove to the emergency department down the street. Thankfully it was a quiet Saturday morning and there was no wait. We were led back through the ED that I had spent months in during my third and fourth years of medical school. It was sort of surreal being in regular clothes with a wrist band with my name on it walking through. I looked around not sure if I wanted to see any of the residents and attendings I had spent time working with. We ultimately made it to the room without seeing anyone. The nurse quickly did her note and vitals as I sat in the bed, very much wanting to jump from the bed to sit in one of the chairs, and not be the patient.

The resident physician, who came in not too long after the nurse, thankfully brought the ultrasound machine in with her. She didn’t ask too many questions, just enough to get the necessary details that I had left out when I told her what brought us in today. Using the phased array probe, she placed the probe on my lower abdomen and began the exam with the screen facing away from me. I’ll never forget the sound my husband made when he saw the screen. Even he, non-medically trained, could see on the screen that there was a fetus but no heartbeat, unlike five short weeks ago. Eventually the resident turned the screen so I could see too. She put the m-mode on and lined it up with where you would expect to see cardiac cell activity and again we did not see any movement, just the “bar code sign” implying no movement. She asked if I wanted a formal ultrasound but we all saw it well enough, so we opted against.

In this moment, she said some things that I will never forget. She said, “I am sorry for your loss” and while holding my hand and looking me in the eye she said, “This is not your fault, you did nothing wrong.” I knew this as a soon to be doctor but as a human being experiencing it right then and there, hearing those words were comforting. Now that I have had time to reflect on it all, I know she said what anyone in my position would want to hear. The resident was incredibly kind, sympathetic, and everything you would want in someone delivering this sort of news. So thank you to her for the words and care she delivered.

Glancing at the discharge paperwork later that day I saw the words “fetal demise in utero.” The medical diagnosis for what had happened. It was fetal demise that lead to a spontaneous abortion, commonly known as a miscarriage. Those words were something I saw on other people’s charts or on slides while studying for exams, and now those words were on my chart and floating around in my head. Even now talking about it with people I find myself using the terms fetal demise rather than miscarriage. I think it’s a conscious choice because it makes it all easier to cope with. I also have an arguably irrational dislike for the word miscarriage because “mis” means wrong and I don’t like that it implies the fetus was “wrongly” carried.

It was a spontaneous fetal demise, most likely due to genetic chromosomal abnormalities. I wish this was more widely know because after sharing my unfortunate news with friends and family I was asked multiple times how something like this happened and what caused it. The answer to these questions are one in four pregnancies end in the first trimester commonly due to genetic abnormalities and nothing I did caused it.

As awful as this experience has been it has given me a great deal of insight into how I hope to approach this situation as the doctor on the other side. It taught me the importance of having the heart to heart about the pregnancy that was lost. Recognizing that no matter how far along a women may be, it can be a devastating loss. It taught me to be very clear in telling the patient, “This is not your fault” and if need be, to share the statistics. I absolutely will be emulating the care I received so that my future patients feel as comforted and supported as I did.

Lastly, I want to thank all the incredibly strong women, both in my life and the ones I have come across since who have shared their pregnancy loss stories with me as well. I know I’m not alone and I hope others who experience it know that too.

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