Sequelae and support after termination of pregnancy for fetal malformation.

Abstract

A retrospective study examined the reactions to the termination of pregnancy for fetal malformation and the follow up services that were available. Women resident in Mid Glamorgan who had had a termination between 1977 and 1981 because of positive findings after midtrimester prenatal diagnostic tests for neural tube defect or chromosome abnormalities were interviewed at home using a semistructured interview schedule. Three retrospective internal comparison groups were formed from those women who had also had a spontaneous abortion, previous stillbirth, or neonatal death or previous termination for medicosocial reasons early in pregnancy. Of the 48 women interviewed, 37 (77%) experienced an acute grief reaction after the index pregnancy was ended. This reaction was akin to that documented after stillbirth or neonatal death. Twenty two women (46%) remained symptomatic six months after the pregnancy had been ended, some requiring psychiatric support, compared with no such reaction after spontaneous abortion or termination for medicosocial reasons. All the women who had previously had a stillbirth or neonatal death were visited at home either by the general practitioner or by the midwife after that event but such follow up was limited to only eight of the study group after termination for fetal malformation.The findings suggest that support is inadequate for these Mid Glamorgan Health Authority, Cardiff J LLOYD, Ms, BS, senior registrar in community medicine

Pregnancy termination due to fetal anomaly: Clinical considerations

“…Most obstetricians may fail to appreciate that pregnancy termination due to fetal anomaly is much more similar to spontaneous perinatal loss than elective abortion (Lloyd & Laurence, 1985; Zeanah et al, 1993). The identical medical procedure may lead medical caregivers to confuse the very different psychological circumstances and consequences of these losses.…”

Schwangerschaftsabbruch aus medizinischer Indikation

“…Die wenigen Veröffentlichungen fokussieren die psychiatrische Morbidität [10] oder allgemeine psychische Folgen [11], weisen jedoch häufig methodische Schwächen auf. Häufig wurden nur kleine Fallzahlen untersucht (n=12-48), [12,13,14,15] oder keine validierten Messinstrumente verwendet [12,13], was die Vergleichbarkeit der Ergebnisse einschränkt. Vorläufi-ge Ergebnisse weisen dennoch darauf hin, dass der Schwangerschaftsabbruch aus medizinischer Indikation zu intensiven Trauerreaktionen führen kann [16].…”

A support group for couples who have terminated a pregnancy after prenatal diagnosis: Recurrent themes and observations

“…Society has only recently begun to recognize that couples who lose a fetus through elective termination of pregnancy for genetic reasons experience a grief reaction similar to and of the same intensity as losing a loved one (Adler and Kushnick, 1982;Blumberg, Golbus, and Hanson, 1975;Donnai, Charles, and Harris, 1981;Elder and Laurence, 1991;Lloyd and Laurence, 1985). The grieving couple needs to work through the mourning process in order to emotionally accept their loss and to be able to move on with their lives (Kubler-Ross, 1967).…”