Medical and psychological interventions after miscarriage and women's distress: a controlled study

Purpose: To examine the impact of medical and psychological interventions on women’s distress after early pregnancy loss. Methods: A case-control study design. Women diagnosed with a missed miscarriage during the ultrasound examination at 10 to 14 weeks of pregnancy; one group received routine care (n=61); one group (n=66) had medical investigations to ascertain the cause of the miscarriage and, at five weeks post-loss, a medical consultation to discuss the results of the investigations; one group received a single session of psychological counselling. The control group was matched to the intervention groups on all relevant socio-demographic and obstetric variables. Measures included the Hospital Anxiety and Depression Scale, Texas Grief Inventory (adjusted for miscarriage), self-blame, and worry about future pregnancy. Assessment was at four weeks after loss, two weeks after the counselling and at four months post-miscarriage. Repeated measures analyses were employed. Results: In all three groups, the scores on all outcome variables decreased significantly from four weeks to four months post-miscarriage. There was a significantly greater decrease in the levels of grief, self-blame and worry, over time in women who received both medical and psychological counselling as compared to the control group. No significant differences were identified between the controls and the group who had medical investigations and a consultation, the exception being the self-blame measure. Conclusions: Psychological counselling, in addition to the medical investigations and a consultation, is likely to be beneficial in reducing women’s distress after miscarriage

A randomised trial of surgical, medical and expectant management of first trimester spontaneous miscarriage

Background: Medical management and expectant care have been considered possible alternatives to surgical evacuation of the uterus for first trimester spontaneous miscarriage in recent years.Aim: To compare the effectiveness and safety of medical and expectant management with surgical management for first trimester incomplete or inevitable miscarriage.Methods: Forty women were recruited following diagnosis of incomplete or inevitable miscarriage, and randomised to surgical, medical or expectant care via an off-site, computerised enrolment system. The primary outcome was the effectiveness of medical (vaginal misoprostol) and expectant management relative to surgical evacuation, assessed at 10&ndash;14 days and 8 weeks post-recruitment. Infection, pain, bleeding, anxiety, depression, physical and emotional recovery were assessed also. Analysis was by intention-to-treat.Results: Effectiveness at 8 weeks was lower for medical (80.0%) and expectant (78.6%) than for surgical management (100.0%). Two women in the medical group had confirmed infections. Bleeding lasted longer in the expectant group than in the surgical group. There were no significant differences in pain, physical recovery, anxiety or depression between the groups. 54.6%, 42.9% and 57.1% of the surgical, medical and expectant groups respectively would opt for the same treatment again.Conclusion: Expectant care appears to be sufficiently safe and effective to be offered as an option for women. Medical management might carry a higher risk of infection than surgical or expectant care.<br /