“I lost the last one — is this happening again?”

Light bleeding with mild cramps in a confirmed early intrauterine pregnancy is threatened miscarriage — but the question of ectopic and significant haemorrhage must always be screened (severe/one-sided pain, shoulder-tip pain, dizziness/syncope, heavy flooding); here they are absent and a recent scan showed a heartbeat. The meaningful "action" is prompt EPAU assessment (a scan) and, because she has had a previous miscarriage and has a scan-confirmed intrauterine pregnancy, vaginal micronised progesterone 400 mg twice daily as NICE NG126 recommends (continued to 16 completed weeks if a heartbeat is confirmed) — not unproven bed rest. Rh status is handled correctly (NICE NG126: no anti-D for threatened miscarriage up to and including 11+6 weeks; she is RhD-positive regardless). But the case is really about communication: respond to the trauma of a previous loss FIRST, give honest balanced information (bleeding is common and many pregnancies continue, but no guarantees), and — the examinable hidden agenda — LIFT the self-blame: normal activity does not cause miscarriage and early loss is almost always chromosomal, never the mother’s fault. Offer genuine non-false reassurance, a concrete EPAU plan, precise emergency safety-netting, and support whatever the outcome.