Pregnant Woman Bleeding At 11 Weeks — Free SCA Practice Case

Character Overview: You are Katie, a 28-year-old who runs an online clothing business. You are about 11 weeks pregnant (this is a much-wanted third pregnancy) and have had light vaginal bleeding for two days, which has frightened you. You feel physically well otherwise. You are anxious and want to know what to do. There is a real practical problem: your husband is away in Germany for three days, you have two young children and no family nearby, so getting to hospital today would be very difficult.

Opening Sentence: "Hi Doctor. I'm around 11 weeks pregnant and I've been bleeding a bit from down below for the last two days. It's not heavy, but I'm terrified it means I'm losing the baby. I don't know what I should do."

History if Asked (Data Gathering Phase)

• ●The bleeding: "It's light — a bit of fresh blood, some spotting, needing a liner rather than pads. No big clots. It's been on and off for two days."
• ●Pain: "No tummy pain, actually. No cramping."
• ●The pregnancy: "My last period was about 11 weeks ago. I did a positive test around six weeks ago. I've been so busy with the business I haven't booked in with the midwife or had any scans yet."
• ●How she feels otherwise: "I feel well in myself — no fever, no dizziness, no feeling faint."
• ●The practical problem: "My husband's in Germany on business for three days. I've got a three-year-old and a one-year-old, one's at nursery. I've no family or friends nearby to help. Getting to a hospital today would be really hard."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

• ●Ideas: Katie assumes bleeding means she is miscarrying. She is not aware that light bleeding can occur without losing the pregnancy, or that an ectopic pregnancy needs excluding. "In my head, bleeding equals miscarriage. I didn't know it could mean anything else, or that it might be okay."
• ●Concerns: Her dominant concern is losing the baby; a related worry is how she will manage everything alone with her husband away. "I'm terrified of losing the baby. And I'm panicking about how I cope on my own with the kids and getting seen."
• ●Expectations: She wants to be told what to do next, and specifically asks whether her husband should cut short his trip and come home. "I just want to know what to do. And should I tell my husband to come straight back?"

If Asked — Medical History and Risk Factors

The patient confirms these details only when directly asked.

• ●Obstetric history: "Two children — a normal birth three years ago, then a caesarean a year ago, which was my choice."
• ●Previous ectopic/miscarriage: "No previous miscarriages or ectopic pregnancies."
• ●Contraception/IUD: "I wasn't using any contraception — this pregnancy was planned. No coil."
• ●Repeat pregnancy test: "I haven't repeated the test since the bleeding started."
• ●Trauma / urinary symptoms / nausea: "No injury, no urinary symptoms, some mild nausea but nothing major."
• ●Allergies: "None."

Social History and Lifestyle Impact

Katie runs an online business from home and lives with her husband and two young children.

• ●Home/support: "Husband away three days, two little ones, no family nearby. It's a lot on my own."
• ●Work: "I run an online clothing business — it's been full-on, which is why I hadn't got round to booking the midwife."
• ●Lifestyle: "Non-smoker, no alcohol, especially now."
• ●Relationship: "Supportive husband, good relationship." (No domestic-abuse concern.)

If Asked — Ectopic Red-Flag Screen

The patient answers these only when directly asked.

• ●If asked about abdominal pain (and whether one-sided): "No tummy pain at all, and certainly nothing one-sided."
• ●If asked about shoulder-tip pain: "No, no pain in my shoulder."
• ●If asked about dizziness, feeling faint, or collapse: "No, I've not felt dizzy or faint."
• ●If asked about palpitations or breathlessness: "No, none of that."
• ●If asked about the volume of bleeding / heavy flooding: "It's light — definitely not flooding or heavy."
• ●If asked about other discharge: "No unusual discharge."
• ●If asked about feeling generally unwell/fever: "No fever, I feel well otherwise."

Responses to Management (The Negotiation Phase)

• ●If the Doctor reassures that light bleeding does not always mean miscarriage: "So it might not be a miscarriage? Bleeding can happen and the pregnancy still be okay?" (The tested point is appropriate reassurance about threatened miscarriage without false promises.)
• ●If the Doctor explains ectopic pregnancy must be excluded: "A pregnancy outside the womb? But I don't have any pain — could it still be that?" (The tested point is explaining why an early scan is needed to confirm the pregnancy is in the womb.)
• ●If the Doctor recommends same-day EPU assessment: "I really can't get to the hospital today with the kids and my husband away. Is there another way?" (The tested point is arranging a workable alternative — a same-day GP assessment with an EPU scan the next day — rather than either insisting or abandoning assessment.)
• ●If the Doctor is asked whether the husband should return: "Should I ring my husband and tell him to fly home right now?"
• ●If the Doctor safety-nets: "What would mean I need to get seen urgently or call 999?"