Anembryonic Demise

38yo. G2P1 AD female scheduled to PCS to Japan within the month. Seen for new OB appt and scheduled to receive physical same day as appt. Due to administrative errors, she had to be rescheduled for physical and dating US two days later (Friday). During US, found to have amniotic sac (consistent with 10-week gestational age) without fetal mass/cells present. Given Cytotec to facilitate clearing of POC with no result (minimal cramping, bleeding consistent with normal period). Seen in ACC for follow-up on Monday for verification of expulsion of POC via US. Amniotic sac still seen intact on vaginal US. Pt given options for removal and chose in-clinic Handi-Vac due to timing of PCS. Handi-Vac procedure completed x1 but vaginal US revealed amniotic sac still intact. With pt consent, 2nd attempt with Handi-Vac performed guided by abd US with positive result. POC retrieved and pt bled appropriately. Given methergine IM x1 with follow-on 2 doses to be picked up at pharmacy. Given 30mg Toradol IM pre-procedure and Epi pudundal block, pt tolerated procedure well.