title: Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation.
abstract: BACKGROUND
  The weight of evidence suggests that women who freely choose to terminate a pregnancy are unlikely to experience significant mental health risks, however some studies have documented psychological distress in the form of posttraumatic stress disorder and depression in the aftermath of termination. Choice of anaesthetic has been suggested as a determinant of outcome. This study compared the effects of local anaesthesia and intravenous sedation, administered for elective surgical termination, on outcomes of pain, cortisol, and psychological distress.
  
  
  METHODS
  155 women were recruited from a private abortion clinic and state hospital (mean age: 25.4 +/- 6.1 years) and assessed on various symptom domains, using both clinician-administered interviews and self-report measures just prior to termination, immediately post-procedure, and at 1 month and 3 months post-procedure. Morning salivary cortisol assays were collected prior to anaesthesia and termination.
  
  
  RESULTS
  The group who received local anaesthetic demonstrated higher baseline cortisol levels (mean = 4.7 vs 0.2), more dissociative symptoms immediately post-termination (mean = 14.7 vs 7.3), and higher levels of pain before (mean = 4.9 vs 3.0) and during the procedure (mean = 8.0 vs 4.4). However, in the longer-term (1 and 3 months), there were no significant differences in pain, psychological outcomes (PTSD, depression, self-esteem, state anxiety), or disability between the groups. More than 65% of the variance in PTSD symptoms at 3 months could be explained by baseline PTSD symptom severity and disability, and post-termination dissociative symptoms. Of interest was the finding that pre-procedural cortisol levels were positively correlated with PTSD symptoms at both 1 and 3 months.
  
  
  CONCLUSIONS
  High rates of PTSD characterise women who have undergone surgical abortions (almost one fifth of the sample meet criteria for PTSD), with women who receive local anaesthetic experiencing more severe acute reactions. The choice of anesthetic, however, does not appear to impact on longer-term psychiatric outcomes or functional status.
authors.affiliation: MRC Research Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Tygerberg, Cape Town, South Africa. sharain@sun.ac.za
authors.forename: Sharain
authors.initials: S
authors.lastname: Suliman
authors.forename: Todd
authors.initials: T
authors.lastname: Ericksen
authors.forename: Peter
authors.initials: P
authors.lastname: Labuschgne
authors.forename: Renee
authors.initials: R
authors.lastname: de Wit
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.forename: Soraya
authors.initials: S
authors.lastname: Seedat
mesh_terms: D000028:Abortion, Induced / Q000379:methods / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D000772:Anesthesia, Local; D001007:Anxiety; D016292:Procedural Sedation; D003863:Depression; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D011247:Pregnancy; D012649:Self Concept; D013315:Stress, Psychological
chemical_list: D006854:Hydrocortisone