Psychological impact on women after second and third trimester termination of pregnancy due to fetal anomalies versus women after preterm birth—a 14-month follow up study

Abstract

The objective of this study was to compare psychiatric morbidity and the course of posttraumatic stress, depression, and anxiety in two groups with severe complications during pregnancy, women after termination of late pregnancy (TOP) due to fetal anomalies and women after preterm birth (PRE). As control group women after the delivery of a healthy child were assessed. A consecutive sample of women who experienced a) termination of late pregnancy in the 2nd or 3rd-trimester (N = 62), or b) preterm birth (N = 43), or c) birth of a healthy child (N = 65) was investigated 14 days (T1), 6 months (T2), and 14 months (T3) after the event. At T1, 22.4% of the women after TOP were diagnosed with a psychiatric disorder compared to 18.5% women after PRE, and 6.2% in the control group. The corresponding values at T3 were 16.7%, 7.1%, and 0%. Shortly after the event, a broad spectrum of diagnoses was found; however, 14 months later only affective and anxiety disorders were diagnosed. Posttraumatic stress and clinician-rated depressive symptoms were highest in women after TOP. The short-term emotional reactions to TOP in late pregnancy due to fetal anomaly appear to be more intense than those to preterm birth. Both events can lead to severe psychiatric morbidity with a lasting psychological impact.

Fear of childbirth, postnatal post-traumatic stress disorder and midwifery care

“…In community studies, up to 7% of women report PTSD in relation to birth (Ayers, Joseph, McKenzieMcHarg, Slade, & Wijma, 2008). Rates of PTSD are higher in high risk groups such as women who have preterm or stillborn infants or life-threatening complications during pregnancy or labour (Elklit et al, 2007;Kersting et al, 2009;Turton et al, 2001). Unlike other postpartum psychopathology, this is an area where there is clear potential to prevent or minimise postpartum PTSD through changing maternity care and services.…”

Brief Internet-Based Intervention Reduces Posttraumatic Stress and Prolonged Grief in Parents after the Loss of a Child during Pregnancy: A Randomized Controlled Trial

“…The loss of an infant due to stillbirth, miscarriage, neonatal death, or termination on the grounds of fetal abnormalities is recognized as a traumatic life event and can cause parents intensive grief and symptoms of posttraumatic stress [2,3,4]. In particular, women whose pregnancies were terminated after the discovery of fetal malformation or severe chromosomal disorders have been found to experience severe symptoms of posttraumatic stress disorder (PTSD) and prolonged grief even years later [4,5,6]. However, despite the increasing recognition that prenatal loss can lead to psychiatric disorders, few of the women affected receive psychological support [7].…”

Women's decision making regarding choice of second trimester termination method for pregnancy complications

“…In fact, there may be a bias toward recommending medical abortion with the belief that viewing the fetus helps women grieve and recover [12]. Grief and posttraumatic stress symptoms are not uncommon after termination for fetal anomaly [10,[13][14][15] and undergoing a procedure that is contrary to a woman's emotional needs may potentially complicate her grief and delay recovery.…”