Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study

Farren, J.; Jalmbrant, Maria; Falconieri, Nora; Mitchell-Jones, Nicola; Bobdiwala, S.; Al‐Memar, M.; Tapp, S.; Calster, Ben Van; Wynants, Laure; Timmerman, Dirk; Bourne, Tom

doi:10.1016/j.ajog.2019.10.102

Cited by 151 publications

(152 citation statements)

References 17 publications

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“…Of those partners who were approached, all were male and 192/386 (50%) were eligible and agreed to participate. This was lower than the participation rate in all eligible women (737/1098 (67%)) for the first aim of the PIEPE study 10 . Of 13 partners who volunteered a reason for non‐participation, nine reported time constraints.…”

Section: Resultsmentioning

confidence: 74%

“…A number of scoring criteria have been proposed; we used criteria involving endorsement of each symptom cluster (re‐experiencing, avoidance and hyper‐arousal clusters) as well as a total severity score cut‐off of ≥ 18, as this has been found to maximize accuracy in the diagnosis of PTSD in victims of motor vehicle accidents and physical and sexual assault 15 . Consistent with our previous publication, we use the term ‘post‐traumatic stress’ rather than ‘post‐traumatic stress disorder’, to acknowledge that our criteria focus on screening for probable PTSD 10 .…”

Section: Methodsmentioning

confidence: 99%

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Differences in post‐traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy between women and their partners: multicenter prospective cohort study

Farren

Jalmbrant

Falconieri

et al. 2021

Ultrasound in Obstet & Gyne

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This is the first study to use a standardised psychometric instrument to assess for symptoms of post-traumatic stress in partners of women who experienced early pregnancy loss. All partners recruited were male. We found that a small proportion of men met the screening criteria for post-traumatic stress, which was lower than the proportion of women at 1 month after early pregnancy loss. What are the clinical implications of this work? There is considerable disparity in the emotional response to early pregnancy loss between women and their partners, which may impact their relationship. Although less frequent, some partners report clinically relevant levels of anxiety, depression and post-traumatic stress symptoms after a loss. Clinicians should consider onward assessment or treatment.

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Section: Resultsmentioning

confidence: 74%

Section: Methodsmentioning

confidence: 99%

Differences in post‐traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy between women and their partners: multicenter prospective cohort study

Farren

Jalmbrant

Falconieri

et al. 2021

Ultrasound in Obstet & Gyne

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show abstract

“…Nevertheless, while we acknowledge that their experiences may differ, our findings show that the responses of women with a history of previous pregnancy loss were not significantly different from those of women without a previous loss. Although this is somewhat unexpected [ 16 , 38 ], it can be explained by the fact that recruitment was promoted by a charity for perinatal loss support and most women who had experienced this particular type of trauma and answered the questionnaire were already being cared for by volunteers and professionals of the organisation. A future multivariate analysis evaluating the role of previous loss together with other sociodemographic and anamnestic variables (such as the presence of psychological disturbances) might help clarifying this point.…”

Section: Study Limitationsmentioning

confidence: 99%

Pregnant women voice their concerns and birth expectations during the COVID-19 pandemic in Italy

et al. 2021

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Background In March 2020, COVID-19 was declared to be a pandemic. While data suggests that COVID-19 is not associated with significant adverse health outcomes for pregnant women and newborns, the psychological impact on pregnant women is likely to be high. Aim The aim was to explore the psychological impact of the COVID-19 pandemic on Italian pregnant women, especially regarding concerns and birth expectations. Methods A cross-sectional online survey of pregnant women in Italy was conducted. Responses were analysed for all women and segregated into two groups depending on previous experience of pregnancy loss. Analysis of open text responses examined expectations and concerns before and after the onset of the pandemic. Findings Two hundred pregnant women responded to the first wave of the survey. Most (n = 157, 78.5%) had other children and 100 (50.0%) had a previous history of perinatal loss. ‘Joy’ was the most prevalent emotion expressed before COVID-19 (126, 63.0% before vs 34, 17.0% after; p < 0.05); fear was the most prevalent after (15, 7.5% before vs 98, 49.0% after; p < 0.05). Positive constructs were prevalent before COVID-19, while negative ones were dominant after (p < 0.05). Across the country, women were concerned about COVID-19 and a history of psychological disorders was significantly associated with higher concerns (p < 0.05). A previous pregnancy loss did not influence women’s concerns. Conclusions Women’s expectations and concerns regarding childbirth changed significantly as a result of the COVID-19 pandemic in Italy. Women with a history of psychological disorders need particular attention as they seem to experience higher levels of concern.

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“… 1 Miscarriage can cause physical harm, such as excessive bleeding and infection, 2 and substantial psychological harm, including anxiety, depression, and post-traumatic stress disorder. 3 , 4 There are two main types of miscarriage that require medical intervention, missed miscarriage and incomplete miscarriage. 5 A missed miscarriage, also known as a delayed or silent miscarriage, is diagnosed when a non-viable pregnancy is identified on ultrasound scan during the first 14 weeks of gestation.…”

Section: Introductionmentioning

confidence: 99%

Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomised, double-blind, placebo-controlled trial

et al. 2020

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Summary Background The anti-progesterone drug mifepristone and the prostaglandin misoprostol can be used to treat missed miscarriage. However, it is unclear whether a combination of mifepristone and misoprostol is more effective than administering misoprostol alone. We investigated whether treatment with mifepristone plus misoprostol would result in a higher rate of completion of missed miscarriage compared with misoprostol alone. Methods MifeMiso was a multicentre, double-blind, placebo-controlled, randomised trial in 28 UK hospitals. Women were eligible for enrolment if they were aged 16 years and older, diagnosed with a missed miscarriage by pelvic ultrasound scan in the first 14 weeks of pregnancy, chose to have medical management of miscarriage, and were willing and able to give informed consent. Participants were randomly assigned (1:1) to a single dose of oral mifepristone 200 mg or an oral placebo tablet, both followed by a single dose of vaginal, oral, or sublingual misoprostol 800 μg 2 days later. Randomisation was managed via a secure web-based randomisation program, with minimisation to balance study group assignments according to maternal age (<30 years vs ≥30 years), body-mass index (<35 kg/m 2 vs ≥35 kg/m 2 ), previous parity (nulliparous women vs parous women), gestational age (<70 days vs ≥70 days), amount of bleeding (Pictorial Blood Assessment Chart score; ≤2 vs ≥3), and randomising centre. Participants, clinicians, pharmacists, trial nurses, and midwives were masked to study group assignment throughout the trial. The primary outcome was failure to spontaneously pass the gestational sac within 7 days after random assignment. Primary analyses were done according to intention-to-treat principles. The trial is registered with the ISRCTN registry, ISRCTN17405024. Findings Between Oct 3, 2017, and July 22, 2019, 2595 women were identified as being eligible for the MifeMiso trial. 711 women were randomly assigned to receive either mifepristone and misoprostol (357 women) or placebo and misoprostol (354 women). 696 (98%) of 711 women had available data for the primary outcome. 59 (17%) of 348 women in the mifepristone plus misoprostol group did not pass the gestational sac spontaneously within 7 days versus 82 (24%) of 348 women in the placebo plus misoprostol group (risk ratio [RR] 0·73, 95% CI 0·54–0·99; p=0·043). 62 (17%) of 355 women in the mifepristone plus misoprostol group required surgical intervention to complete the miscarriage versus 87 (25%) of 353 women in the placebo plus misoprostol group (0·71, 0·53–0·95; p=0·021). We found no difference in incidence of adverse events between the study groups. Interpretation Treatment with mifepristone plus misoprostol was more effective than misoprostol alone in t...

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Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study

Cited by 151 publications

References 17 publications

Differences in post‐traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy between women and their partners: multicenter prospective cohort study

Differences in post‐traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy between women and their partners: multicenter prospective cohort study

Pregnant women voice their concerns and birth expectations during the COVID-19 pandemic in Italy

Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomised, double-blind, placebo-controlled trial

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