Clinical and psychological impact after surgical, medical or expectant management of first‐trimester miscarriage – a randomised controlled trial

Abstract

Without substantial differences in the clinical and psychological impact between different treatment modalities, a more conservative approach with expectant management for miscarriage may be an option for women.

Case Control Study of Anxiety and Depression Among Patients with Miscarriage Compared to Those with Successful Pregnancy

“…Thapar and Thapar (1992) reported similar finding of greater anxiety within 24 hrs and at 6 wks, following loss compared to a normal pregnant women. Psychological distress after miscarriage had been frequently assessed using various self-reporting questionnaires, such as the Hospital Anxiety and Depression Scale (HADS), the Center for Epidemiological StudiesDepression Scale (CES-D), Self-rating Anxiety Scale (SAS) and General Health Questionnaire-12 (Prettyman et al 1993;Gong et al 2013;Kong et al 2013). Hospital Anxiety and Depression Scale is a self-assessment scale that has been developed and found to be a reliable and validate instrument for detecting states of anxiety and depression in the setting of a hospital medical outpatient clinic (Zigmoid and Snaith 1983).…”

Author's reply re: The impact of supportive counselling on women's psychological wellbeing after miscarriage – a randomised controlled trial

“…1 Thus, we believe that the treatment modalities will not significantly alter the risk of psychological distress after miscarriage.…”

Increasing the management options for early pregnancy loss: the economics of miscarriage

“…4,5 Medical management with vaginal misoprostol will result in a completed miscarriage in 60-90% of patients. [4][5][6][7] Expectant management has the greatest variation in success rates, ending in a completed miscarriage for 38-81% of patients. [8][9][10] Although expectant management has been shown to increase overall days of bleeding and the risk of unscheduled surgical intervention or hospitalization, 8,11 patient satisfaction rates remain high for all approaches.…”

“…[8][9][10] Although expectant management has been shown to increase overall days of bleeding and the risk of unscheduled surgical intervention or hospitalization, 8,11 patient satisfaction rates remain high for all approaches. 7,8,12,13 Obviously, a patient's presentation may strongly dictate management-at times, surgical evacuation in the operating room may be required for a patient with profound bleeding. However, most patients with EPL are not diagnosed in the midst of an acute episode requiring immediate surgical intervention.…”

“…Some patients may even worry that more active management represents a potential risk to their health. 7 These varied interventions are also associated with significantly different costs. Although costs are rarely appreciated in the individual patient encounter, the overall costs of managing patients with EPL are significant and should at least be considered.…”