14
Pregnancy loss

https://doi.org/10.1016/j.bpobgyn.2013.08.012Get rights and content

Women who lose desired pregnancies by miscarriage, stillbirth, or genetic termination are at risk of suffering from grief, anxiety, guilt and self-blame that may even present in subsequent pregnancies. It is important to find effective means of helping women deal with these losses. The approach to stillbirth has shifted from immediately removing the child from the mother to encouraging the parents to view and hold the baby. This approach has been questioned as possibly causing persistent anxiety and post-traumatic stress disorder. Women who miscarry are currently encouraged to find ways to memorialise the lost fetus. Couples who decide to terminate a pregnancy after discovering a defect may deal not only with sadness but also guilt. Immediate crisis intervention and follow-up care should be available, recognising that individual women may experience different reactions and their specific post-loss needs must be assessed.

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

References (54)

  • J.P. Neilson et al.

    Medical treatments for incomplete miscarriage (less than 24 weeks)

    Cochrane Database of Syst Rev

    (2013; Mar 28)
  • R.M. Stirtzinger et al.

    The psychologic effects of spontaneous abortion

    CMAJ

    (1989)
  • M. Beutel et al.

    Grief and depression after miscarriage: their separation, antecedents, and course

    Psychosom Med

    (1995)
  • N. Brier

    Grief following miscarriage: a comprehensive review of the literature

    J Womens Health (Larchmt)

    (2008)
  • G.E. Robinson et al.

    Psychological reactions of women followed for 1 year after miscarriage

    J Reprod Infant Psychol

    (1994)
  • R. Neugebauer et al.

    Major depressive disorder in the six months after miscarriage

    JAMA

    (1997)
  • H.J. Janssen et al.

    A prospective studying of risk factors predicting grief intensity following pregnancy loss

    Arch Gen Psychiatry

    (1997)
  • R.M. Stirtzinger et al.

    Parameters of grieving in spontaneous abortion

    Int J Psychiatry Med

    (1999)
  • A.V. Nikcevic et al.

    Investigation of the course of miscarriage and its influence on women’s psychological distress

    Br J Obstet Gynaecol

    (1999)
  • N. Brier

    Anxiety after miscarriage: a review of the empirical literature and implications for clinical practice

    Birth

    (2004)
  • A.V. Nikcevic et al.

    Psychological outcomes following missed abortions and provision for follow-up care

    Ultrasound Obstet Gynecol

    (1998)
  • G.W.S. Kong et al.

    Gender comparison of psychological reaction after miscarriage – a 1-year longitudinal study

    BJOG

    (2010)
  • K.J. Gold et al.

    Marriage and cohabitation outcomes after pregnancy loss

    Pediatrics

    (2010)
  • R.E. Roose et al.

    Perinatal grief and support spans the generations: parents’ and grandparents’ evaluations of an intergenerational perinatal bereavement program

    J Perinat Neonat Nurs

    (2011)
  • L.C. Callister

    Perinatal loss: a family perspective

    J Perinat Neonat Nurs

    (2006)
  • O. Johnson et al.

    Proof of Life: a protocol for pregnant women who experience pre-20-week perinatal loss

    Crit Care Nurs Q

    (2010)
  • D. Wing

    Grief following perinatal loss and the impact of hospital based support service

    (2002)
  • Cited by (0)

    View full text