Psychological сomponents of miscarriage. Ways to overcome

Abstract

Habitual miscarriage is a stressful condition and a significant factor of frustration for married couples. The psycho-emotional state of the pregnant woman affects the course of the subsequent pregnancy and its outcome. Correction of the psychological component of habitual miscarriage is a promising direction for preventing reproductive losses. The aim of the work is to study the psychological components of miscarriage and determine the ways of their correction. Materials and methods. The level of chronic stress was studied in pregnant women with symptoms of miscarriage and a history of habitual reproductive losses (main group) based on indicators of psychoemotional state, the condition of the autonomic nervous system, and the degree of activation of stress-implementing systems. The results were evaluated with the scale PSS, PSM-25 as adapted by N. Ye. Vodopianova, Spielberger–Khanin inventory and the scale by L. D. Malkova, Baevsky index, cortisol content in the blood and urine. The pregnant women with a physiological course of pregnancy and uncomplicated history were included in the control group. Based on the fact that the etiology of habitual miscarriage is multifactorial, and the psychological component is amenable to correction, stress-protective therapy was included in the treatment complex of habitual miscarriage. To assess the effectiveness of treatment, the main group was divided into subgroups: 1 – with psychotherapy, 2 – without psychotherapy. Results. A high level of personal perception of stress, anxiety and asthenia determine the psycho-emotional state of the main group pregnant women, among whom two dominant psycho types were identified: A – a high level of anxiety and low neuropsychic resistance; B – poise and good adaptive ability against the background of stress. Non-drug stress-protective therapy in the complex of miscarriage treatment contributes to: a decrease in psycho-emotional stress in pregnant women with psycho type A – 2.6 times, anxiety level – 1.7 times, asthenia level – 2.3 times; and also: a decrease in similar indicators in pregnant women with psycho type B – 1.6 times, 3.9 times and 2.5 times, respectively (P < 0.05); a decrease in the frequency of premature termination of pregnancy by more than 11 %. Conclusions. The psychological component of miscarriage is a high level of personal perception of stress, anxiety and asthenia. Stress-protective therapy in combination with pathogenetic therapy of miscarriage improves pregnancy outcomes for the mother and the fetus. It is advisable to conduct pregravid training with the participation of a psychologist in women with a history of reproductive losses in order to overcome the psychological component of stress perception, expand adaptive potential, increase neuropsychic stability, and form a positive orientation toward pregnancy and motherhood.

Features of the state of extraembryonic structures in miscarriage early terms of pregnancy

“…Moreover, the embryonic period (up to 70 days of gestation) accounts for 10-12% and only 2-3% of pregnancies are terminated at the fetal stage of the child's development [14]. Therefore, the processes that occur in the chorio-embryonic system Участь естраембріональних структур в інтеграції обмінних процесів між організмом матері і ембріона є незаперечною [15]. Однак компесаторнопристосувальні можливості хоріо-плацентарної систе ми мають певний резерв, при виснаженні якого настають незворотні патологічні зміни, які можуть бути причиною порушень життєво-важливих функцій майбутнього плода та сприяти розвитку несприятливих наслідків і репродуктивних втрат [16].…”

“…The participation of estraembryonic structures in the integration of exchange processes between the organism of the mother and the embryo is undeniable [15]. However, the compensatory and adaptive capabilities of the chorio-placental system have a certain reserve, when depleted, irreversible pathological changes occur, which can be the cause of violations of the vital functions of the future fetus and contribute to the development of adverse consequences and reproductive losses [16].…”