Non-pharmacological anxiety reduction with immersive virtual reality for first-trimester dilation and curettage: a pilot study.

OBJECTIVES: Most women experience moderate to severe pain during first-trimester surgical termination of pregnancy despite the application of various analgesic techniques. Studies have shown that virtual reality (VR) is effective in reducing anxiety among a range of women in differing circumstances. Our study objectives were to assess the feasibility of using VR during first-trimester dilation and curettage under local anaesthesia and understand the effect of VR on procedure-related anxiety during first-trimester dilation and curettage. METHODS: A pilot feasibility study was conducted in a convenience sample of 30 women (15 in the intervention group and 15 in the control group). Anxiety scores were recorded before, during and after the procedure. In-depth interviews were conducted after the procedure. RESULTS: Participants reported that VR was either very effective (53%) or somewhat effective (40%) in relieving anxiety during and after the procedure. Eleven participants used the VR device for the entire procedure and four participants removed it during the procedure. The anxiety scores before the procedure were not significantly different between the groups. The intervention group had a median five point post-procedure decrease in anxiety score rated on a visual analogue scale, which was significantly different from that of the control group. Overall, participants had a positive experience but there were some technological frustrations. CONCLUSION: Women undergoing dilation and curettage in the first trimester were able to use a VR device during the procedure. VR-induced distraction and relaxation helped to reduce anxiety in some participants both during and after the procedure.

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

BACKGROUND: The management of first-trimester miscarriage has been studied extensively in recent years. However, relatively little attention has been focussed on woman's satisfaction and psychological impact from different treatment modalities. AIM: To investigate the clinical and psychological outcomes of surgical, medical and expectant management of first-trimester miscarriage. MATERIALS AND METHODS: A prospective randomised controlled trial of 180 women suffering miscarriage managed by either surgical evacuation, medical evacuation or expectant management was conducted in a university-affiliated, tertiary referral hospital. The complete miscarriage rate, clinical symptomatology, complications, women's satisfaction and the psychological impact were evaluated. RESULTS: Women in surgical evacuation (98.1%) had a significantly higher complete miscarriage rate when compared with medical evacuation (70%) and expectant management (79.3%). Women who had surgical evacuation had significantly shorter duration of vaginal bleeding, but higher rate of infection. Women who had medical evacuation had significantly more gastrointestinal symptoms. Despite differences in efficacy and complication profile, there was no significant difference in satisfaction among groups. There were no significant differences in terms of psychological well-being, depression scores, anxiety level, fatigue symptoms as measured in General Health Questionnaire-12, Beck Depression Inventory, Spielberger's State Anxiety Inventory and fatigue scale at treatment and four weeks after treatment. However, women with active intervention had greater post-traumatic stress symptoms as measured in Chinese version of Impact of Event Scale-Revised at the time of treatment when compared with women in expectant management. CONCLUSION: 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.

Preoperative anxiety among patients who were about to receive uterine dilatation and curettage.

BACKGROUND: From our clinical experience, preoperative anxiety are quite common among women who were about to receive uterine dilatation and curettage (D&C). However these conditions have not yet been studied. The authors aimed to examine the prevalence of anxiety as well as the underlying specific concerns among this group of patients. MATERIAL AND METHOD: The authors assessed preoperative anxiety in 383 women who were about to receive D&C by using the Hospital Anxiety and Depression Scale and questionnaires to assess specific concern toward this operation. RESULTS: Prevalence of preoperative anxiety was 23.2%. Among the pregnant subjects, preoperative anxiety was associated with concern over being approached in lithotomy position and concern with the procedure. For the non-pregnant subjects, high preoperative pain score, marital status, having no medical expense reimbursement, distrust in medical personnel, concern over being approached in lithotomy position, and intra-operative pain are associated with anxiety. CONCLUSION: Preoperative anxiety is quite common among this group of patients. Understanding the underlying specific concern of women who are about to receive D&C will help medical personnel to provide more effective management strategies in making the patients more comfortable.

A qualitative study on patients' perceptions of expectant management of first trimester incomplete miscarriage.

INTRODUCTION: Efficacy and safety of expectant management of first trimester miscarriage are well known, though the patients' perceptions and attitudes are less clear. This study was designed to understand the women's perception of symptoms, acceptability, fertility wishes and care received. METHODS: A qualitative study among 25 women who were allocated to the expectant management arm of a randomised control trial, which compared expectant versus surgical management of incomplete miscarriage, was carried out. Interviews were recorded at the end of two weeks from the initial diagnosis based on five themes, which were transcribed and analysed. RESULTS: Out of the 25 interviewed, two had to undergo surgical evacuation due to failed expectant management. Excessive bleeding was the main concern especially for employed women. Ideas and beliefs of family members influenced the women's experience. Majority preferred expectant management in a possible future event. Many expected to conceive again but preferred to delay a pregnancy even in the absence of any contraindications. Inadequate knowledge of expectant management led to dissatisfaction regarding the care received. CONCLUSIONS: Better understanding on the natural course of events in spontaneous miscarriage will help not only the patient but also the relatives in accepting expectant management of first trimester miscarriage and influence their ideas, beliefs and feelings. Improved health education, counselling, and symptomatic relief are important aspects in improving the overall quality of care.

Women's experiences of three early miscarriage management options: a qualitative study.

BACKGROUND: Miscarriage affects around one in six pregnancies. Much research has taken place identifying the consequences of this for parents but is mainly quantitative. Of the limited qualitative studies, none have explored women's experiences of the methods of miscarriage management received. AIM: To assess the social and personal impact of different management methods (expectant, medical and surgical) on women's experience of first trimester miscarriage. DESIGN OF STUDY: Qualitative interviews using a topic guide with a purposive cohort of four categories of women (each management method plus non-participants) 6 months to 1 year after first trimester miscarriage. Focus groups with both research participants and health workers. SETTING: Women from three hospitals in the South West of England that participated in the Miscarriage Treatment (MIST) trial. METHOD: Seventy-two interviews were undertaken between September 1999 and June 2000. There were also five focus groups (47 participants) and two feedback sessions (8 participants) with written feedback from 12 women. Interviews lasted 0.5-2.5 hours generating over 2000 A4 pages of transcripts. The transcripts were analysed for common themes, using standard proformas, which were filled in by individual team members and then discussed by the whole research team. Iterative readings in the light of new emerging issues ensured that new themes could be identified throughout the analytical process. All transcripts were then encoded for the identified themes using NUDIST. RESULTS: Common themes emerged across all management options although some were specific to just one or two management options. The five major themes arising out of the data analysis were: intervention; experiences of care; finality; the 'baby'; and pain and bleeding. CONCLUSIONS: Women's experiences and beliefs vary widely and their preferences need to be considered in their early miscarriage management. The three methods have different benefits and problems from the women's point of view. Competence and caring from professionals are especially important.

Respuesta del estado psicológico en adolescentes con interrupción del embarazo. Villa Clara 2004 / Psichological state response in adolescents with abortion. Villa Clara 2004

En nuestro país, como en muchos otros, el embarazo ocurre con mayor frecuencia que en el pasado en edades cada vez más tempranas, con los consabidos riesgos y complicaciones para la salud. Con tal propósito se realizó un estudio descriptivo y prospectivo en 175 adolescentes de un universo de 996 mujeres, en las que se llevó a cabo la interrupción del embarazo en el policlínico "XX Aniversario" del Municipio Santa Clara, durante el período comprendido desde Febrero de hasta Septiembre del 2003 con el objetivo de determinar el grupo de edades, así como estado civil de las adolescentes estudiadas. Distinguir significativamente la correspondencia entre edad gestacional e interrupciones del embarazo. Precisar las causas fundamentales que motivaron la interrupción del embarazo. Evaluar la respuesta del estado psicológico antes de la interrupción del embarazo. Establecer la relación entre métodos anticonceptivos y vías de interrupción de este. Concluyendo que prevaleció el grupo etario entre 16 y 17 años, solteras. De 10 a 12 semanas de gestación la más frecuentes, en la mayoría de las adolescentes no existía antecedentes de interrupción del embarazo. La causa fundamental de interrupción fue no desear tener hijos por estar estudiando. La ansiedad y el miedo fueron los estados afectivos más frecuentes en el estudio. Los medios masivos de difusión constituyeron las vías fundamentales de conocimiento de métodos anticonceptivos(AU)

Comparison of perinatal grief after dilation and evacuation or labor induction in second trimester terminations for fetal anomalies.

OBJECTIVE: This study was undertaken to compare grief resolution after dilation and evacuation (D&E) or induction of labor (IOL) for second-trimester pregnancy termination. STUDY DESIGN: A prospective cohort of 49 women choosing second-trimester abortion caused by fetal anomalies by either medical IOL or D&E. Depression was evaluated by using the Edinburgh Postnatal Depression Scale and bereavement was assessed by using the Perinatal Grief Scale with follow-up to 12 months after pregnancy termination. Data were analyzed with chi 2 tests, Mann-Whitney U tests, and independent and paired sample t tests. RESULTS: There was no significant difference in depression incidence on enrollment (61.9% D&E, 53.8% IOL, P = .579), at 4 months (23.5% D&E, 14.3% IOL, P = .252) or 12 months (27.3% D&E, 20.0% IOL, P = .696) or on the PGS at 4 months (74.1 vs 90.2, P = .351) or 12 months (73.3 vs 86.4, P = .658). CONCLUSION: There is no significant difference in grief resolution among women who terminate a desired pregnancy by either medical or surgical abortion.

Psychological and cardiovascular predictors of anaesthesia induction, operative and post-operative complications in minor gynaecological surgery.

This study aimed to clarify the pre-operative-personality-post-operative-recovery association by considering anaesthetic variables. Additionally, the work investigated the relationships between psychological and cardiovascular functioning and anaesthetic induction difficulties and operative problems. Two minor gynaecological procedures were evaluated (dilatation and curettage, laparoscopy) which differ greatly in anaesthetic and operative techniques. Psychological factors predicted cardiovascular responding immediately prior to the induction of anaesthesia, and combinations of cardiovascular and psychological variables were associated with anaesthetic induction, operative and post-operative problems. Health locus of control and worry concerning the various stages of the operation emerged as the most consistent psychological predictors of peri-operative outcome in both procedures.

Four hugs a day using therapeutic touch.

Imagine a prescription which prescribed four hugs per day to a patient suffering from depression. Hanning described findings that four hugs per day was an antidote for depression, eight hugs per day would achieve mental stability and twelve hugs per day would achieve real psychological growth. If this is the case, touch has a greater significance than most of us would realise. The following assignment was written whilst I was undertaking ENB 176 using reflective practice to explain the benefits or problems in using certain techniques.

[Effect and side effects of oral morphine, lormetazepam and placebos as premedication]. / Die Wirkung und Nebenwirkung oralen Morphins, Lormetazepams und Plazebos zur Prämedikation.

In 60 patients undergoing a curettage in thiopentone induced inhalation anaesthesia with enflurane and N2O/O2 = 2:1, the effects of oral premedication (2 h before anaesthesia) with 30 mg morphine (MST 30) (n = 21), 1 mg lormetazepam (Noctamid) (n = 19) and placebo (n = 21) on psychological (anxiety, depression and asthenia), physiological (blood pressure, heart and respiratory rate) and pain parameters (visual analogue scale, analgesic consumption) were investigated. The study design was single blind, randomized. Before premedication the three groups did not differ in one parameter and so were comparable. MST 30 had a significantly better anxiolytic, Lormetazepam a significantly better antidepressive effect than the compared substance. There were no differences in blood pressure and heart rate. In contrast to lormetazepam and placebo after MST 30 there was no increase in the respiratory rate which can be explained by the anxiolytic stress reducing effect. There was no difference in peri- and intraoperative pain parameters, probably due to the type of surgery. Nausea and vomiting occurred more frequently after MST 30, but there was no significance. A higher rate was probably prevented by the application of transdermal scopolamine the day before surgery. The indication of analgesics (opiates) for premedication is discussed taking the controversy into account. The results of this study show that oral morphine (MST 30) has an anxiolytic effect, one of the most important effects a premedication should have. Further studies should investigate in which types of surgery the analgesic effect of MST 30 is peri- and intraoperatively relevant, so that advantages compared to e.g. Flunitrazepam, Midazolam or Lormetazepam in a higher dosage could be expected.

Dilatation and evacuation for induced abortion in developing countries: advantages and disadvantages.

PIP: The gestational age threshold of 12 weeks for induced abortion by curettage procedures has been challenged in the US and other developed countries. Dilatation and evacuation procedures take a shorter time, have a lower failure rate, are less expensive, and have a lower incidence of complications than either instillation or hysterotomy techniques. Thus dilatation and evacuation may offer unique advantages to higher risk women in developing countries and may make more efficient use of the limited personnel and facilities in these areas.^ieng