Breaking uncertain news in early pregnancy — communication station

Communication and shared-decision station: explaining a pregnancy of unknown location to a woman expecting a yes-or-no answer. Tests plain-language explanation of diagnostic uncertainty, the 48-hour hCG plan, explicit safety-netting, and recognition of psychological impact. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 29-year-old woman attends the early pregnancy assessment service alone. She is 6 weeks by dates, has had two days of light bleeding and mild cramping, and is well. Her transvaginal scan shows an empty uterus with no adnexal mass and no free fluid; her serum hCG is 1120 IU/L. She has been waiting two hours and believes she is here to be told whether the baby is alive. You must explain the result, the plan and the safety net, and obtain her agreement to it.

Station brief

Format. Communication station, approximately 12 minutes, with a simulated patient and one assessor. There is no examination and no procedure. You are the gynaecology registrar; the scan and the hCG result are in front of you. ^[1]

Candidate instruction. Explain the findings to her, agree a plan for the next 48 hours, and make sure she leaves knowing exactly what to watch for and who to call. She is alone and has no support person present. ^[1]^[2]

References6Show

[1]Royal College of Obstetricians and Gynaecologists Diagnosis and Management of Ectopic Pregnancy: Green-top Guideline No. 21 BJOG, 2016.PMID 27813249
[2]Barnhart K, van Mello NM, Bourne T, et al. Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome Fertil Steril, 2011.PMID 20947073
[3]Farren J, Jalmbrant M, Falconieri N, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study Am J Obstet Gynecol, 2020.PMID 31953115
[4]Bobdiwala S, Christodoulou E, Farren J, et al. Triaging women with pregnancy of unknown location using two-step protocol including M6 model: clinical implementation study Ultrasound Obstet Gynecol, 2020.PMID 31385381
[5]Bobdiwala S, Kyriacou C, Christodoulou E, et al. Evaluating cut-off levels for progesterone, β human chorionic gonadotropin and β human chorionic gonadotropin ratio to exclude pregnancy viability in women with a pregnancy of unknown location: A prospective multicenter cohort study Acta Obstet Gynecol Scand, 2022.PMID 34817062
[6]National Institute for Health and Care Excellence Ectopic pregnancy and miscarriage: diagnosis and initial management NICE guideline NG126, 2026.Source

Breaking uncertain news in early pregnancy — communication station

Station brief

References6Show

[1]Royal College of Obstetricians and Gynaecologists Diagnosis and Management of Ectopic Pregnancy: Green-top Guideline No. 21 BJOG, 2016.PMID 27813249
[2]Barnhart K, van Mello NM, Bourne T, et al. Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome Fertil Steril, 2011.PMID 20947073
[3]Farren J, Jalmbrant M, Falconieri N, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study Am J Obstet Gynecol, 2020.PMID 31953115
[4]Bobdiwala S, Christodoulou E, Farren J, et al. Triaging women with pregnancy of unknown location using two-step protocol including M6 model: clinical implementation study Ultrasound Obstet Gynecol, 2020.PMID 31385381
[5]Bobdiwala S, Kyriacou C, Christodoulou E, et al. Evaluating cut-off levels for progesterone, β human chorionic gonadotropin and β human chorionic gonadotropin ratio to exclude pregnancy viability in women with a pregnancy of unknown location: A prospective multicenter cohort study Acta Obstet Gynecol Scand, 2022.PMID 34817062
[6]National Institute for Health and Care Excellence Ectopic pregnancy and miscarriage: diagnosis and initial management NICE guideline NG126, 2026.Source