Social support and subjective assessment of psychophysical condition, health, and satisfaction with quality of life among women after pregnancy loss.

BACKGROUND: The task of modern medicine is not just to heal, but also to improve the patient's well-being and achieve non-medical goals in the therapy process that enable effective physical, mental and social functioning of the patient. Social support in difficult situations mobilizes an individual's strength and resources to cope with problems. Research on social support and women's condition after pregnancy loss reflects a holistic approach to the patient and is important from the perspective of increasing the level of hospital care. OBJECTIVE: The aim of our study was to assess the impact of social support on the psychophysical condition, health, and satisfaction with quality of life among women after miscarriage and ectopic pregnancy. METHODS: The cross-sectional study was carried out in a group of 500 patients after miscarriage and 110 with ectopic pregnancy, hospitalized in hospitals in Lublin (Poland). The study was conducted with the use of a diagnostic survey, comprising the Berlin Social Support Scales (BSSS) and an original survey questionnaire (psychophysical condition, satisfaction with health and quality of life on a scale of 1-4, sources of support on a scale of 1-10, with 1 being the poorest rating). RESULTS: Respondents after miscarriage and those after ectopic pregnancy assigned the highest scores to the degree of perceived available instrumental support (respectively, miscarriage: M = 3.79, EP: M = 3.77). Women after pregnancy loss assigned the highest score to the support obtained from their partner (respectively, miscarriage: M = 9.26, EP: M = 9.23). Social support was significantly correlated with the condition of patients hospitalized as a result of pregnancy loss (p < 0.05). The assessment of psychophysical condition, health, and QoL of the respondents is determined by their education, financial standing, and obstetric history (p < 0.05). CONCLUSIONS: Women hospitalized due to miscarriage and ectopic pregnancy assigned high scores to the level of perceived available instrumental, emotional, and actually received social support. There is a positive relationship between social support and subjective opinion about psychophysical condition, health and satisfaction with quality of life among women after pregnancy loss. The assessment is determined by sociodemographic factors and the respondents' obstetric history.

Social prevalence of knowledge about ectopic pregnancy - tip of the 'health inequalities' iceberg?

We aimed to assess the social and demographic factors determining the level of awareness of the signs and symptoms of ectopic pregnancy (EP) in an East London female population and determine if awareness was related to adverse outcomes. This was a prospective, observational study using a structured questionnaire to assess awareness of EP. A retrospective analysis of a database of EP patients was used to assess the association between adverse clinical outcomes and knowledge about EP. A younger age (<20 years) (p = .024), higher education (p = .008), higher income (p = .002), professional (p = .008), white ethnicity (p= <.00001), single (p = .037) and an awareness of the media (p = .030) were statistically significantly related to a higher knowledge. A significant difference was seen between the white and all other ethnicities in the amount of blood loss (p = .033). The relative risks (RRs 1.169) of having >500 ml of blood loss were higher in the ethnic minorities. RR of >500 ml of blood loss if Asian compared to white is 1.1034 and if black compared to white is 1.1201. Blacks are more likely than whites and Asians to have blood loss >1000 ml (p = .019). An ethnic minority, a lower education level, the older age groups, those with a lower income and with non-professional careers are linked to a lower level of knowledge about EP. Ethnic minority communities have a higher risk of adverse clinical outcomes.Impact StatementWhat is already known on this subject? Research has identified demographic and social factors which prove that victims of health inequalities are usually the poor and the marginalised.What the results of this study add? To-date, our study is the only one to establish that the level of knowledge about ectopic pregnancy (EP) is influenced by demographic and socioeconomic factors and that lower levels of knowledge are significantly associated with adverse clinical outcomes. Our findings show that ethnic minority women are more likely to suffer morbidity from EP than their Caucasian counterparts. We have also established that women of poorer backgrounds, women with lesser levels of education and in non-professional jobs are least likely to be aware of signs and symptoms and consequences of EP.What the implications are of these findings for clinical practice and/or further research? The health service has a responsibility to identify these populations and target them for interventions to correct these health inequalities. We propose a multifaceted plan to increase the level of knowledge of these identified sections of the local community.

Differences in post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy between women and their partners: multicenter prospective cohort study.

OBJECTIVES: To investigate and compare post-traumatic stress (PTS), depression and anxiety in women and their partners over a 9-month period following miscarriage or ectopic pregnancy. METHODS: This was a prospective cohort study. Consecutive women and their partners were approached in the early pregnancy units of three hospitals in central London. At 1, 3 and 9 months after early pregnancy loss, recruits were e-mailed links to surveys containing the Hospital Anxiety and Depression Scale and the Post-traumatic Stress Diagnostic Scale. The proportion of participants meeting the screening criteria for moderate or severe anxiety or depression and PTS was assessed. Mixed-effects logistic regression was used to analyze differences between women and their partners and their evolution over time. RESULTS: In total, 386 partners were approached after the woman in whom the early pregnancy loss had been diagnosed consented to participate, and 192 couples were recruited. All partners were male. Response rates were 60%, 48% and 39% for partners and 78%, 70% and 59% for women, at 1, 3 and 9 months, respectively. Of the partners, 7% met the criteria for PTS at 1 month, 8% at 3 months and 4% at 9 months, compared with 34%, 26% and 21% of women, respectively. Partners also experienced lower rates of moderate/severe anxiety (6% vs 30% at 1 month, 9% vs 25% at 3 months and 6% vs 22% at 9 months) and moderate/severe depression (2% vs 10% at 1 month, 5% vs 8% at 3 months and 1% vs 7% at 9 months). The odds ratios for psychological morbidity in partners vs women after 1 month were 0.02 (95% CI, 0.004-0.12) for PTS, 0.05 (95% CI, 0.01-0.19) for moderate/severe anxiety and 0.15 (95% CI, 0.02-0.96) for moderate/severe depression. Morbidity for each outcome decreased modestly over time, without strong evidence of a different evolution between women and their partners. CONCLUSIONS: Some partners report clinically relevant levels of PTS, anxiety and depression after pregnancy loss, though to a far lesser extent than women physically experiencing the loss. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Prioritizing Desiredness in Pregnancy of Unknown Location: An Algorithm for Patient-Centered Care.

Patient-centered care is one of the six aims for improvement in health care quality outlined by the National Academy of Medicine (previously known as the Institute of Medicine). We propose an algorithm for patients who are presenting with a pregnancy of unknown location that emphasizes pregnancy desiredness to improve patient-centered care. Health care professionals should assess pregnancy desiredness at a patient's initial consultation for evaluation of pregnancy of unknown location; desiredness, along with other clinical criteria, should guide management. For women with an undesired pregnancy, health care professionals should offer expedient active management. Uterine aspiration will allow for quick clinical diagnosis and resolution of the pregnancy. Alternatively, for women with a desired pregnancy or for those who are ambivalent, we recommend careful conservative management. Adopting this algorithm will recenter the patient in the complex management of pregnancy of unknown location.

Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study.

BACKGROUND: Early pregnancy losses are common, but their psychologic sequelae are often overlooked. Previous studies have established links between miscarriage and early symptoms of anxiety and depression. However, the incidence of posttraumatic stress symptoms and the psychologic response specifically to ectopic pregnancies have not been investigated. OBJECTIVE: The purpose of this study was to investigate levels of posttraumatic stress, depression, and anxiety in women in the 9 months after early pregnancy loss, with a focus on miscarriage and ectopic pregnancy. Morbidity at 1 month was compared with a control group in healthy pregnancy. STUDY DESIGN: This was a prospective cohort study. Consecutive women were recruited from the early pregnancy and antenatal clinics at 3 London hospitals and received emailed surveys that contained standardized psychologic assessments that included the Hospital Anxiety and Depression Scale and Posttraumatic stress Diagnostic Scale, at 1, 3, and 9 months after loss. Control subjects were assessed after a dating scan. We assessed the proportion of participants who met the screening criteria for posttraumatic stress and moderate/severe anxiety or depression. We used logistic regression to calculate adjusted odds ratios. RESULTS: Seven hundred thirty-seven of 1098 women (67%) with early pregnancy loss (including 537 miscarriages and 116 ectopic pregnancies) and 171 of 187 control subjects (91%) agreed to participate. Four hundred ninety-two of the women with losses (67%) completed the Hospital Anxiety and Depression Scale after 1 month; 426 women (58%) completed it after 3 months, and 338 women (46%) completed it after 9 months. Eighty-seven control subjects (51%) participated. Criteria for posttraumatic stress were met in 29% of women with early pregnancy loss after 1 month and in 18% after 9 months (odds ratio per month, 0.80; 95% confidence interval, 0.72-0.89). Moderate/severe anxiety was reported in 24% after 1 month and in 17% after 9 months (odds ratio per month, 0.69; 95% confidence interval, 0.50-0.94). Moderate/severe depression was reported in 11% of the women after 1 month and 6% of the women after 9 months (odds ratio per month, 0.87; 95% confidence interval, 0.53-1.44). After miscarriage, proportions after 9 months were 16% for posttraumatic stress, 17% for anxiety, and 5% for depression. Corresponding figures after ectopic pregnancy were 21%, 23%, and 11%, respectively. In contrast, among control women with viable pregnancies, 13% reported moderate-to-severe anxiety (odds ratio loss at 1 month vs controls: 2.14; 95% confidence interval, 1.14-4.36), and 2% reported moderate-to-severe depression (odds ratio loss at 1 month vs control subjects: 3.88; 95% confidence interval, 1.27-19.2). CONCLUSION: Women experience high levels of posttraumatic stress, anxiety, and depression after early pregnancy loss. Distress declines over time but remains at clinically important levels at 9 months.

The psychological impact of early pregnancy loss.

BACKGROUND: Early pregnancy loss (EPL) is a common event, with scope for long-term personal and societal impact. There are three decades worth of published evidence of profound psychological sequelae in a significant proportion of women. However, the wide variety of outcomes, screening instruments, assessment timings and geographical locations makes it challenging to form a coherent picture of the morbidity within the whole group and its subgroups. OBJECTIVE AND RATIONALE: This review aims to investigate three questions. (1) What is the evidence for depression, anxiety and post-traumatic stress disorder (PTSD) following a miscarriage or an ectopic pregnancy in women and/or their partners? (2) What is the intensity and duration of these conditions, and how do they compare to those without losses? (3) Which patients have been found to be at highest risk of psychopathology? Answers to these questions are salient not only in day-to-day clinical interactions with those experiencing EPL, whose psychological needs may not be prioritized, but should also form the basis for tailoring healthcare policy in terms of screening for and treating the associated psychological morbidity. SEARCH METHODS: The following databases were searched, from the start of each database up to July 2017: MEDLINE (Ovid interface, 1948 onwards), Embase classic + Embase (Ovid interface, 1947 onwards), and PsychINFO (Ovid interface, 1806 onwards). Search strategies were developed using medical subject headings (MeSH). The concepts of psychological morbidity (anxiety, depression or PTSD) and pregnancy loss (miscarriage or ectopic pregnancy) were first expanded with the Boolean operator 'or', then linked together using 'and'. Included studies were of prospective cohort design, including women or men following EPL (with the majority to have experienced losses before 24 weeks gestation), and reporting standardized psychometric measures for anxiety, depression and post-traumatic stress disorder. The timing of follow-up had to be specified and standardized across participants. Manuscript quality and risk of bias was assessed using the Newcastle-Ottawa Scale. OUTCOMES: We found evidence of significant depression and anxiety in the first month following EPL in women. Partners were also shown to display depression and anxiety, albeit to a generally lower level. There is also evidence of post-traumatic stress symptoms relating to the EPL in three studies. WIDER IMPLICATIONS: In view of their high frequency, EPLs can significantly contribute to the overall burden of psychopathology within a population. Recognition of this impact is important, so that severely affected individuals may be screened and treated appropriately. Further research to establish risk factors to promptly identify and treat these patients, and to optimize their management, is crucial.

Irish women's experience of Ectopic pregnancy.

OBJECTIVE: Ectopic pregnancy can become a life threatening condition. Due to the specific nature of Ectopic pregnancy the grief experienced may well be overlooked compared to other pregnancy losses. Fertility concerns for the future and recovery from surgical or medical treatment may instead become the focus of care. The objective of this study was to gain insight into women's experience of Ectopic pregnancy. STUDY DESIGN: A qualitative semi-structured interview format was utilised. Seven women who had experienced an Ectopic pregnancy in a large tertiary-level Irish maternity hospital were interviewed. This sample was recruited purposively ensuring inclusion of women whose treatment included expectant, medical or surgical management. MAIN OUTCOME MEASURES: Interpretative phenomenological analysis was employed as the analytic strategy as it has an ideographic approach which allows us to gain insight into the women's experiences of Ectopic pregnancy. RESULTS: Key findings were the importance of clear information on treatment options, the diagnostic scan was highlighted as important as it helped the women emotionally detach from the pregnancy. Lack of bereavement counselling and satisfactory completion of outpatient care hindered closure and recovery for these women. There was increased apprehension about fertility and women reported feeling reluctant to conceive again. Women reported difficulty coming to terms with their diagnosis which in turn impacted their recovery and illustrated women's reservations to embark on future pregnancies. CONCLUSIONS: This study has implications for the care of women who experience Ectopic pregnancy particularly in relation to how they are managed from diagnosis to completion of treatment.

Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study.

OBJECTIVES: This is a pilot study to investigate the type and severity of emotional distress in women after early pregnancy loss (EPL), compared with a control group with ongoing pregnancies. The secondary aim was to assess whether miscarriage or ectopic pregnancy impacted differently on the type and severity of psychological morbidity. DESIGN: This was a prospective survey study. Consecutive women were recruited between January 2012 and July 2013. We emailed women a link to a survey 1, 3 and 9 months after a diagnosis of EPL, and 1 month after the diagnosis of a viable ongoing pregnancy. SETTING: The Early Pregnancy Assessment Unit (EPAU) of a central London teaching hospital. PARTICIPANTS: We recruited 186 women. 128 had a diagnosis of EPL, and 58 of ongoing pregnancies. 11 withdrew consent, and 11 provided an illegible or invalid email address. MAIN OUTCOME MEASURES: Post-traumatic stress disorder (PTSD) was measured using the Post-traumatic Diagnostic Scale (PDS), and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). RESULTS: Response rates were 69/114 at 1 month and 44/68 at 3 months in the EPL group, and 20/50 in controls. Psychological morbidity was higher in the EPL group with 28% meeting the criteria for probable PTSD, 32% for anxiety and 16% for depression at 1 month and 38%, 20% and 5%, respectively, at 3 months. In the control group, no women met criteria for PTSD and 10% met criteria for anxiety and depression. There was little difference in type or severity of distress following ectopic pregnancy or miscarriage. CONCLUSIONS: We have shown a large number of women having experienced a miscarriage or ectopic pregnancy fulfil the diagnostic criteria for probable PTSD. Many suffer from moderate-to-severe anxiety, and a lesser number depression. Psychological morbidity, and in particular PTSD symptoms, persists at least 3 months following pregnancy loss.

Depression, stress and guilt are linked to the risk of suicide associated to ectopic pregnancy / Depressão, estresse e culpa ligam-se ao risco de suicídio associado à gestação ectópica

OBJECTIVE: To identify the risk for suicidal behavior in women who had a fetal loss resulting from ectopic pregnancy and verify the association of suicide risk with depression and psychosocial aspects. METHODS: Thirty-one women diagnosed with an ectopic pregnancy were interviewed. Major depression was identified using the Primary Care Evaluation of Mental Disorders questionnaire. The Prenatal Psychosocial Profile questionnaire was used to measure stress, social support and self-esteem. RESULTS: We found that 16% (n = 5) reported suicide risk behavior. The correlation between suicide risk and symptoms of major depression, stress and guilt was statistically significant. CONCLUSIONS: Depression and stress have been linked to the presence of suicide risk, further increasing the vulnerability of women with ectopic prgnancy, which generates intense emotional reactions as guilt.

OBJETIVO: identificar o risco de comportamento suicida em mulheres que apresentaram perda fetal resultante de gestação ectópica e verificar a associação entre risco suicida com depressão e aspectos psicológicos. MÉTODO: Trinta e uma mulheres diagnosticadas com gestação ectópica foram entrevistadas. Diagnóstico de Depressão maior foi identificado através do questionário Primary Care Evaluation of Mental Disorders. O questionário Prenatal Psychosocial Profile foi utilizado para avaliação de estresse, suporte social e auto-estima. RESULTADOS: Foi encontrado índice de 16% (n = 5) de mulheres que reportaram risco de comportamento suicida. A correlação entre risco suicida e sintomas de depressão maior, estresse e culpa foi estatisticamente significante. CONCLUSÃO: Depressão e estresse estiveram relacionados com a presença de risco suicida, aumentando a vulnerabilidade das mulheres com gestação ectópica, o que gera reações emocionais intensas como a culpa.

Embarazo cornual y metotrexato en multidosis / Cornual pregnancy and multidose methotrexate

El embarazo cornual es una patología poco frecuente pero con una elevada mortalidad si no se diagnostica precozmente. La ecografía vaginal permite un diagnóstico precoz y la realización de un tratamiento conservador con metotrexato, reduciendo la morbimortalidad materna. Presentamos un caso de una gestante diagnosticada de embarazo cornual derecho no accidentado que fue tratada con metotrexato multidosis con éxito

Cornual pregnancy is a rare condition but has high mortality unless diagnosed early. Early diagnosis with transvaginal ultrasound allows conservative treatment with methotrexate, thus reducing maternal morbidity and mortality. We report a case of an unruptured right cornual pregnancy successfully treated with multidose systemic methotrexate

Randomized comparison of health-related quality of life in women with ectopic pregnancy or pregnancy of unknown location treated with systemic methotrexate or expectant management.

OBJECTIVE: To study the impact on health-related quality of life (HRQoL) of treatment with systemic methotrexate (MTX) or expectant management in women with ectopic pregnancy or pregnancy of unknown location (PUL) with low and plateauing serum hCG concentrations. STUDY DESIGN: HRQoL was assessed alongside a randomized clinical trial (RCT) with the use of standard self-administered psychometric measure questionnaires. PATIENTS AND SETTING: All women who participated in the multicenter RCT comparing treatment with systemic MTX to expectant management in women with ectopic pregnancy or persisting PUL were eligible for the HRQoL measurements. MAIN OUTCOME MEASURE: HRQoL measures of three standardized questionnaires (SF-36, RSCL, HADS). RESULTS: Data were available for 64 of 73 women (78%) randomized in the RCT. We found no difference in HRQoL between the two treatment groups. The need for additional treatment, i.e. additional MTX injections or surgical intervention, had no impact on HRQoL. CONCLUSION: Women treated with MTX or expectant management for an ectopic pregnancy or persisting PUL have comparable quality of life.

Dispositivos intrauterinos liberadores de levonorgestrel: beneficios frente a dudas, temores y creencias erróneas / Levonorgestrel releasing intrauterine devices: benefits versus doubts, fears and misperceptions

El uso inconsistente del preservativo y la falta de cumplimiento con la píldora, los dos métodos más usados en nuestro país, dan lugar cada año a un número importante de embarazos no deseados. Diversas sociedades médicas internacionales recomiendan el uso de anticonceptivos de larga duración reversibles (LARC), altamente efectivos al no depender de la participación activa de la usuaria, para evitar los embarazos no deseados en todas las mujeres, salvo que exista alguna contraindicación. Entre éstos, los dispositivos intrauterinos de cobre (DIU-Cu) y el liberador de levonorgestrel (DIU-LNG), una evolución de los anteriores, son los más populares. Pese a sus beneficios, apenas un 6 % de las mujeres los usa en nuestro país. Esto puede deberse a la existencia de dudas, temores y creencias erróneas entre los profesionales sanitarios y las mujeres que crean una barrera a su uso. En la presente revisión se analizan los beneficios que ofrece el DIU-LNG y se da respuesta a las dudas, temores y creencias erróneas más extendidas, tales como las mujeres elegibles para usarlo, la recuperación de la fertilidad, el uso tras el parto, el coste, las dificultades en la inserción o el riesgo de enfermedad inflamatoria pélvica, de infertilidad y de embarazos ectópicos. El desconocimiento de los DIU entre las mujeres, y en especial del DIU-LNG, es muy alto. Se revisan también aquellos aspectos específicos en los que es importante asesorar a la usuaria

Inconsistent use of condoms and lack of compliance with oral contraceptive pills, both the most widespread used methods in Spain, result in high rates of unintended pregnancies yearly. Several international medical societies do recommend the use of long acting reversible contraceptive methods (LARC methods), highly effective because of no need for user’s active participation, to prevent pregnancies in all women, unless specific contraindication determined. Within them, cooper intrauterine device (Cooper-IUD) and levonorgestrel releasing intrauterine device (LNG-IUD), an evolution from the first one, are the most popular ones. Despite of their proved benefits, only 6 % of women are using them in our country. A barrier has been created around the use of intrauterine devices, ought to healthcare providers and users’ fears, misperceptions and doubts. In the present review we analyse those benefits offered by LNG-IUD, giving response to the most extended myths, misperceptions and fears such as women’s adequate profile, fertility recovery, postpartum use, cost, insertion inconveniences, or risk for pelvic inflammatory disease, infertility or ectopic pregnancies. Unawareness of intrauterine devices within women, particularly of LNG-IUD, is unexpectedly high. Specific issues around contraceptive counselling are also included in this review

[Somatoform disorders in neurology visits: history and circumstances: retrospective study of 124 cases]. / Symptômes somatomorphes en consultation de neurologie : expression, soubassement et occasion : étude rétrospective de 124 situations.

We report 124 cases of somatoform disorders, considering psychogenic disorders at the same level as neurological disorders. We noted any psychic, somatic or social condition (history taking) and facilitating circumstances. The patients were aged 16 to 84 years old; 71.7% were women. We observed pain (35.4%), psychogenic headache (25%), sensorimotor loss (27.4%), gait and psychogenic tremor (17.7%), cognitive disorders (11.8%), ocular symptoms (7.2%), and urogenital symptoms (2.4%). Delay to consultation ranged from a few days to 20 years. Psychiatric comorbidity was noted in 30.6% of the cases. In 55.6% of 124 cases, we observed a psychological background. It was a childhood trauma in 15.3% of these cases. In one-third of the 124 situations, we noted an underlying somatic or social condition. Facilitation conditions were frequently mixed. Somatic and/or psychological conditions were noted in one-third of the 124 cases and social conditions in half of them. The neurologist is faced with the challenge of naming the symptom (most often labelled a functional disorder) and of making the decision to stop or limit investigations. Visits by patients with psychogenic disorders make up a significant percentage of neurology speciality appointments. The neurologist should not limit the consultation to differentiating "real" symptoms from psychogenic somatoform disorders, but should also propose a straightforward compassionate approach for effective therapeutic care. By carefully listening to the patient's dialogue, the neurologist can help the patient give meaning to the symptoms, and progress towards improved well-being.

Effects of progressive muscle relaxation training on anxiety and quality of life of inpatients with ectopic pregnancy receiving methotrexate treatment.

We explored the effects of progressive muscle relaxation training on anxiety and health-related quality of life of patients with ectopic pregnancy receiving methotrexate treatment. Ninety inpatients receiving this treatment were randomly assigned to a progressive muscle relaxation group (n = 45) or a control group (n = 45). The control group received standard single-dose methotrexate treatment, and the experimental group received methotrexate and additional muscle relaxation training until hospital discharge. The patients were evaluated with the state form of the State-Trait Anxiety Inventory and SF-36 shortly after admission and before discharge from the hospital. Both covariance analysis and repeated measures ANOVA showed that muscle relaxation training can effectively improve the anxiety and health-related quality of life of patients with ectopic pregnancy receiving methotrexate treatment in an inpatient setting.

Grieving after early pregnancy loss--a common reality.

A miscarriage can be very traumatic for a couple and their immediate family. The aim of this study was to assess, using the Perinatal Grief Scale (PGS), whether the type of early pregnancy loss influences the severity of grief and whether the presence of living children influences the severity of grief. Over a period of 6 months in 2008, seventy five patients were recruited for the study, of which 7 (9.3%) had molar pregnancies, 20 (26.7%) had ectopic pregnancies, 43 (573%) had a miscarriage and 5 (6.7%) had recurrent miscarriages. In this study there was no significant difference in severity of grief, between women that had a miscarriage and ectopic pregnancy (p = 0.14) or, between women that had a miscarriage and a molar pregnancy (p = 0.85). Women who had experienced a ectopic pregnancy did not have a higher grief intensity than the women that had a molar pregnancy (p = 0.75). However, for women with a child, the grief intensity significantly increases with the number of miscarriages (p = 0.015). Women with no children with an ectopic pregnancy grieve significantly more than those with a child (p = 0.019). An appointment for the 'Miscarriage Clinic' should be offered to all of these women but special attention should be paid to those in the categories most at risk

Economic evaluation of diagnosing and excluding ectopic pregnancy.

BACKGROUND: The diagnosis of ectopic pregnancy in women presenting in early pregnancy is often protracted, relying on costly investigations that are psychologically burdensome to the patient. The aim of this study was to evaluate the financial costs to the health services in Scotland of the current methods used to diagnose and exclude ectopic pregnancy, and compare these with that of a theoretical single diagnostic serum biomarker. METHODS: We conducted a retrospective cost-description analysis (with and without costs of diagnostic laparoscopy) of the health-care costs incurred by all patients presenting to a large Scottish teaching hospital between June and September 2006 with pain and bleeding in early pregnancy, where ectopic pregnancy was not excluded. Additionally, a cost minimization analysis was performed for the costs of current ectopic pregnancy investigations versus those of a theoretical single diagnostic serum biomarker. This included sensitivity analyses where the biomarker was priced at increasing values and assumed to have less than 100% diagnostic sensitivity and specificity. RESULTS: About 175 patients were eligible to be included in the analysis. Forty-seven per cent of patients required more than three visits to diagnose or exclude ectopic pregnancy. The total yearly cost for diagnosing and excluding ectopic pregnancy was 197K pound sterling for the hospital stated, and was estimated to be 1364K pound sterling for Scotland overall. Using a theoretical diagnostic serum biomarker we calculated that we could save health services up to 976K pound sterling (lowest saving 251K pound sterling after subanalysis) every year in Scotland. CONCLUSIONS: Ectopic pregnancy is expensive to diagnose and exclude, and the investigation process is often long and might involve significant psychological morbidity. The development of a single diagnostic serum biomarker would minimize this morbidity and lead to significant savings of up to 1 million pounds per year in Scotland.

Diagnosing miscarriage.

Miscarriage is the most common serious pregnancy complication affecting approximately 30% of biochemical pregnancies and 11-20% of clinically recognised pregnancies. The diagnosis of miscarriage is made most commonly by trans-vaginal ultrasound (TVS) assessment. Evidence-based criteria should be employed for the diagnosis of delayed and incomplete miscarriage. Complete miscarriage should not be diagnosed with TVS alone without serial biochemical confirmation (unless an intrauterine gestation sac has previously been visualised). After a clinical assessment suggesting complete miscarriage, 45% of women will have retained tissue on ultrasound, whilst women with an ultrasound scan showing an empty uterus with a history suggestive of miscarriage will be found to have an ectopic pregnancy in 6% of cases. Prediction of the diagnosis of miscarriage using maternal history and ultrasound features may be helpful in counselling women towards likely pregnancy outcome and planning appropriate further assessment. Use of three-dimensional ultrasound has not improved diagnosis of miscarriage. After a diagnosis of miscarriage, half the women undergo significant psychological effects, which may last for up to 12 months.

Dreams of my daughter: an ectopic pregnancy.

Autoethnographic narrative, personal journal excerpts, and artifacts were employed to narrate the story of my ectopic pregnancy and experiences with the medical field. The name "Doctor" is invoked as a way of objectifying yet protecting the anonymity of the doctor who objectified and did not protect me. A methodological discussion of the following tensions in autoethnography is presented: intimacy/professionality, art/science, showing/explaining.