Pregnancy after loss — structured oral station (12 minutes)

Opening prompt — "Tell me what you do today."

Model response — say it in this order: ^[1][2]

• "I would see her today. The wait is part of the harm in pregnancy after loss, and an early reassurance scan is part of the care."
• "I would introduce myself, sit down, acknowledge the four months since the loss and the two sleepless nights, and ask what she is most worried about before I touch the probe."
• "I would offer a transvaginal scan with her partner present if she wishes, warn her before each step, and tell her the result in plain words. If the pregnancy is viable, I would confirm the heartbeat visually and verbally; if it is not, I would deliver that news in the same room, well."

Examiner is listening for: acknowledgement of the loss, an early scan offered without judgement, plain words, and a plan for either outcome. ^[1]

Probe 1 — "She asks whether she should have waited longer to conceive."

• "There is no evidence-based reason to make her wait. The Kangatharan meta-analysis of over one million women found that conceiving within six months of a miscarriage was not associated with adverse outcomes, and was associated with lower risks of further miscarriage (RR 0.82, 95% CI 0.78 to 0.86) and preterm delivery (RR 0.79, 95% CI 0.75 to 0.83)."
• "I would tell her that, and I would not impose a six-month wait."^[4]

Probe 2 — "How will you screen her mental health in this pregnancy?"

• "At every contact, with the EPDS for depression and the PASS for anxiety. I would not screen for depression only — the Farren cohort found that 38% of women met criteria for probable PTSD three months after early pregnancy loss, and the EPDS alone misses that."
• "The PASS identified 68% of women with a diagnosed anxiety disorder, against 36% for the EPDS anxiety subscale. I would also ask directly about self-harm and suicidal ideation, document the answer, and refer the same day where indicated."^[2][3]

Probe 3 — "She wants progesterone because her friend took it and had a successful pregnancy."

• "I would hold the evidence honestly. PROMISE, in women with unexplained recurrent miscarriage, found no significant difference in live birth between progesterone (65.8%) and placebo (63.3%) — relative rate 1.04, 95% CI 0.94 to 1.15. PRISM reached the same conclusion in women with bleeding in early pregnancy."
• "I would not offer progesterone as a certainty. If she still wishes to take it after that conversation, I would document the shared decision — but I would not let the prescription substitute for the surveillance, the screening and the continuity that this pregnancy actually needs."^[5]

Probe 4 — "She will be 11 weeks on the date her last baby died. What do you do about that?"

• "Name the anniversary and plan for it. I would offer a scan on or around that date, in clinic, with continuity of carer, and I would tell her in advance what we will do — and what we will do if the news is bad."
• "Anniversary reactions are common and treatable; the plan is to anticipate, not to react when she presents in crisis to the emergency department."^[1][2]

Probe 5 — "The partner has been silent. How do you bring him in?"

• "I would address him directly, by name, and ask how he is doing. Men consistently report being treated as the support act rather than as a patient; he is at risk too, and his grief may be running on a different timeline to hers."
• "I would offer him a brief, separate assessment and a route to support in his own right. Couples with divergent grief styles are common and treatable."^[1]

Probe 6 — "What is the evidence base for the dedicated pregnancy-after-loss model?"

• "The Rainbow Clinic case-control study (Le Vance 2025) for women with a prior stillbirth found that the composite adverse perinatal outcome was significantly less in the Rainbow Clinic group than in the pre-clinic control group — OR 0.46, 95% CI 0.22 to 0.98. Gestational age at delivery was greater, with a significant reduction in very and extreme preterm delivery."
• "Even outside a dedicated clinic, the principles travel: continuity, screening, surveillance and an honest evidence base."^[6]