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Psychological impact of early miscarriage and client satisfaction with treatment : comparison between expectant management and misoprostol treatment in a randomized controlled trial

Fernlund, A. LU ; Jokubkiene, L. LU ; Sladkevicius, P. LU orcid ; Valentin, L. LU orcid and Sjöström, K. (2021) In Ultrasound in Obstetrics and Gynecology 58(5). p.757-765
Abstract

Objectives: To compare the short- and long-term emotional distress (grief, anxiety and depressive symptoms) after early miscarriage and satisfaction with treatment between women randomized to expectant management vs vaginal misoprostol treatment. Methods: This was a preplanned analysis of data collected during a randomized controlled trial comparing expectant management with misoprostol treatment in women with early anembryonic or embryonic miscarriage and vaginal bleeding. If the miscarriage was not complete on day 31 after inclusion, surgical evacuation was recommended. The main outcomes were levels of anxiety and grief, depressive symptoms and client satisfaction with the treatment, which were assessed using the following validated... (More)

Objectives: To compare the short- and long-term emotional distress (grief, anxiety and depressive symptoms) after early miscarriage and satisfaction with treatment between women randomized to expectant management vs vaginal misoprostol treatment. Methods: This was a preplanned analysis of data collected during a randomized controlled trial comparing expectant management with misoprostol treatment in women with early anembryonic or embryonic miscarriage and vaginal bleeding. If the miscarriage was not complete on day 31 after inclusion, surgical evacuation was recommended. The main outcomes were levels of anxiety and grief, depressive symptoms and client satisfaction with the treatment, which were assessed using the following validated psychometric self-assessment instruments: Spielberger State–Trait Anxiety Inventory (STAI, Form Y), Perinatal Grief Scale (PGS), Montgomery–Åsberg Depression Rating Scale (MADRS-S; self-reported version) and Client Satisfaction Questionnaire (CSQ-8). All women were assessed at four timepoints: on the day of randomization, on the day when the miscarriage was judged to be complete, and at 3 months and 14 months after complete miscarriage. The psychometric and client satisfaction scores were compared between the misoprostol group and the expectant-management group at each assessment. Analysis was performed by the intention-to-treat principle. Results: Ninety women were randomized to expectant management and 94 to misoprostol treatment. The psychometric and client satisfaction scores were similar in the two treatment groups at all assessment timepoints. At inclusion, 41% (35/86) of the women managed expectantly and 37% (34/92) of those treated with misoprostol had a STAI-state score of > 46 (‘high level of anxiety’), and 9% (8/86) and 10% (9/91), respectively, had symptoms of moderate or severe depression (MADRS-S score ≥ 20). In both treatment groups, symptom scores for anxiety and depression were significantly higher at inclusion than after treatment and remained low until 14 months after complete miscarriage. Grief reactions were mild in both groups, with a median PGS score of 40.0 at 3 months and 37.0 at 14 months after complete miscarriage in both treatment groups. Four women treated with misoprostol and two women managed expectantly had a PGS score of > 90 (indicating deep grief) 3 months after complete miscarriage, while one woman managed expectantly had a PGS score of > 90 14 months after complete miscarriage. Women in both treatment groups were satisfied with their management, as indicated by a median CSQ-8 score of > 25 at each assessment. More than 85% of participants in each of the two groups reported that they would recommend the treatment they received to a friend. Conclusions: The psychological response to and recovery after early miscarriage did not differ between women treated with misoprostol and those managed expectantly. Satisfaction with treatment was high in both treatment groups. Our findings support patient involvement when deciding on the management of early miscarriage.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anxiety, depression, miscarriage, misoprostol, pregnancy complications, psychology, randomized controlled trial, spontaneous abortion
in
Ultrasound in Obstetrics and Gynecology
volume
58
issue
5
pages
9 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:33798287
  • scopus:85116884604
ISSN
0960-7692
DOI
10.1002/uog.23641
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
id
17d4593a-8dcf-48e5-a524-357e04cb4964
date added to LUP
2021-11-16 17:40:09
date last changed
2024-03-23 13:38:52
@article{17d4593a-8dcf-48e5-a524-357e04cb4964,
  abstract     = {{<p>Objectives: To compare the short- and long-term emotional distress (grief, anxiety and depressive symptoms) after early miscarriage and satisfaction with treatment between women randomized to expectant management vs vaginal misoprostol treatment. Methods: This was a preplanned analysis of data collected during a randomized controlled trial comparing expectant management with misoprostol treatment in women with early anembryonic or embryonic miscarriage and vaginal bleeding. If the miscarriage was not complete on day 31 after inclusion, surgical evacuation was recommended. The main outcomes were levels of anxiety and grief, depressive symptoms and client satisfaction with the treatment, which were assessed using the following validated psychometric self-assessment instruments: Spielberger State–Trait Anxiety Inventory (STAI, Form Y), Perinatal Grief Scale (PGS), Montgomery–Åsberg Depression Rating Scale (MADRS-S; self-reported version) and Client Satisfaction Questionnaire (CSQ-8). All women were assessed at four timepoints: on the day of randomization, on the day when the miscarriage was judged to be complete, and at 3 months and 14 months after complete miscarriage. The psychometric and client satisfaction scores were compared between the misoprostol group and the expectant-management group at each assessment. Analysis was performed by the intention-to-treat principle. Results: Ninety women were randomized to expectant management and 94 to misoprostol treatment. The psychometric and client satisfaction scores were similar in the two treatment groups at all assessment timepoints. At inclusion, 41% (35/86) of the women managed expectantly and 37% (34/92) of those treated with misoprostol had a STAI-state score of &gt; 46 (‘high level of anxiety’), and 9% (8/86) and 10% (9/91), respectively, had symptoms of moderate or severe depression (MADRS-S score ≥ 20). In both treatment groups, symptom scores for anxiety and depression were significantly higher at inclusion than after treatment and remained low until 14 months after complete miscarriage. Grief reactions were mild in both groups, with a median PGS score of 40.0 at 3 months and 37.0 at 14 months after complete miscarriage in both treatment groups. Four women treated with misoprostol and two women managed expectantly had a PGS score of &gt; 90 (indicating deep grief) 3 months after complete miscarriage, while one woman managed expectantly had a PGS score of &gt; 90 14 months after complete miscarriage. Women in both treatment groups were satisfied with their management, as indicated by a median CSQ-8 score of &gt; 25 at each assessment. More than 85% of participants in each of the two groups reported that they would recommend the treatment they received to a friend. Conclusions: The psychological response to and recovery after early miscarriage did not differ between women treated with misoprostol and those managed expectantly. Satisfaction with treatment was high in both treatment groups. Our findings support patient involvement when deciding on the management of early miscarriage.</p>}},
  author       = {{Fernlund, A. and Jokubkiene, L. and Sladkevicius, P. and Valentin, L. and Sjöström, K.}},
  issn         = {{0960-7692}},
  keywords     = {{anxiety; depression; miscarriage; misoprostol; pregnancy complications; psychology; randomized controlled trial; spontaneous abortion}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{757--765}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Ultrasound in Obstetrics and Gynecology}},
  title        = {{Psychological impact of early miscarriage and client satisfaction with treatment : comparison between expectant management and misoprostol treatment in a randomized controlled trial}},
  url          = {{http://dx.doi.org/10.1002/uog.23641}},
  doi          = {{10.1002/uog.23641}},
  volume       = {{58}},
  year         = {{2021}},
}