Best Practice & Research Clinical Obstetrics & Gynaecology
14Pregnancy loss
Introduction
The loss of a desired pregnancy by miscarriage, stillbirth or termination for genetic indications can result in grief, guilt, self-doubt, anxiety and post-traumatic stress disorder (PTSD). These losses may result in immediate and long-term psychological consequences. Caregivers need to identify the best practices for managing women and their partners who have experienced such losses. Recent research has raised questions about the efficacy of practices that have become the standard of care in many settings.
Section snippets
Miscarriage
Miscarriage or spontaneous abortion is defined as an unintended termination of pregnancy resulting in fetal death before 20 weeks of gestation. The overall incidence is 15–20%; 27% in women between aged between 25 and 29 years and 75% in women aged over 45 years [1]. About three-quarters of losses occur before week 12. Although the causes of these losses are numerous, in the case of a first or second miscarriage, causes are seldom investigated and often remain unknown.
Early symptoms of
Stillbirth
Stillbirth is the death of a fetus after 20 weeks gestation or after reaching 14 oz in weight. Sometimes, the mother is aware that the fetus has stopped moving. In these cases, the mother still has to go through labour to deliver a dead fetus. In other situations, the fetus was alive at the beginning of labor but died in the process of the delivery. Often the cause remains unknown. As almost one-half of stillbirths occur in apparently uncomplicated pregnancies, most parents are unprepared when
Genetic terminations
Genetic terminations or terminations for genetic indications are highly stressful events. Some women go into a pregnancy knowing that they are carriers of a genetic defect and worry they will pass this defect along to the fetus. In other cases, the woman has no known pre-existing risk but encounters a problem during pregnancy, such as being exposed to Rubella, which puts her at risk for damage to the fetus. In the third instance, women over the age of 35 years are generally offered prenatal
Conclusion
Unwanted pregnancy loss may be associated with a great deal of pain and grief. Each type of loss has similarities and differences. All may be associated with grief, anxiety, fear of future infertility, and difficulties in seeing the pregnancies or babies of others. Whether unanticipated, such as miscarriage or stillbirth, or chosen, such as genetic terminations, the losses tend to be associated with guilt and self-blame. The effect of these losses is not associated with the length of gestation
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