How can I effectively counsel a patient with a previous pregnancy loss about the management of her current high-risk pregnancy?

When counselling a patient with a previous pregnancy loss about managing her current high-risk pregnancy, provide sensitive, individualized support and information, recognising the emotional impact and potential distress associated with prior loss ¹.

Advise early referral or self-referral to an early pregnancy assessment service that operates 7 days a week, where she can receive timely ultrasound and serum hCG assessments to closely monitor the pregnancy ¹.

Offer vaginal micronised progesterone 400 mg twice daily if she presents with vaginal bleeding and has a confirmed intrauterine pregnancy, continuing treatment until 16 completed weeks if a fetal heartbeat is confirmed, as this may reduce the risk of miscarriage ¹.

Explain the management options clearly, including expectant, medical, or surgical management if miscarriage occurs, tailored to her clinical situation and preferences, and provide both oral and written information to support informed decision-making ¹.

Ensure she knows when and how to seek urgent help if symptoms worsen or new symptoms develop, including providing a 24-hour contact number ¹.

Offer follow-up appointments after any pregnancy loss to discuss concerns, emotional support, and future pregnancy planning ¹.

Provide information about support and counselling services, including leaflets and helpline contacts, to help her cope with the psychological impact of previous loss and current high-risk pregnancy ¹.