How should I counsel a patient who has experienced a miscarriage regarding future pregnancy planning?

When counselling a patient who has experienced a miscarriage regarding future pregnancy planning, it is important to provide clear, compassionate information tailored to her clinical situation and emotional needs. First, explain that it is common to experience a range of emotions after miscarriage and offer information about available emotional support and counselling services, including peer support and psychological interventions to help her cope with the loss ¹.

Advise the patient to seek follow-up care with a healthcare professional within 3 weeks after the miscarriage to rule out retained products of conception, molar pregnancy, or ectopic pregnancy, and to assess the need for further treatment ². This follow-up is crucial to ensure complete recovery and to address any complications.

Discuss the expected recovery period, including when it is safe to resume sexual activity and when she can consider trying to conceive again. While specific timing may vary, many women can attempt conception once bleeding has stopped and they feel physically and emotionally ready, but this should be individualized ².

Provide information about the potential impact of miscarriage and its management on future fertility, reassuring that most women can conceive successfully after miscarriage, but also acknowledging that recurrent miscarriage may require further evaluation and support ² (Rock and Zacur, 1983).

Explore the patient’s pregnancy intentions and contraceptive needs, as some women may wish to avoid immediate conception while others may want to try again soon. Offer access to the full range of reversible contraceptive options if pregnancy is not desired immediately, ensuring that healthcare professionals are knowledgeable and able to provide these options promptly ¹ (Roe et al., 2020).

If the patient has a history of previous miscarriage and presents with vaginal bleeding in a future pregnancy, consider offering vaginal micronised progesterone to reduce the risk of miscarriage, continuing treatment until 16 completed weeks if a fetal heartbeat is confirmed, noting this is an off-label use ².

Encourage the patient to self-refer to early pregnancy assessment services in future pregnancies if she has concerns, especially if she has had recurrent miscarriage or ectopic pregnancy, to facilitate early assessment and management ².

Overall, counselling should be individualized, empathetic, and include clear information on physical recovery, emotional support, fertility expectations, contraception, and early pregnancy care pathways to optimize outcomes and patient well-being after miscarriage.