The influence of medical and psychological interventions on women's distress after miscarriage.
OBJECTIVE
The aim of this study was to examine the impact of medical and psychological interventions on women's distress after early miscarriage.


METHODS
This was a prospective study of women attending for a routine scan at 10-14 weeks of gestation and found to have a missed miscarriage. An intervention group of 66 women had medical investigations to ascertain the cause of miscarriage, and at 5 weeks after the scan, they all had a medical consultation to discuss the results of the investigations. These 66 women were randomly allocated into a group which received further psychological counselling (MPC, n=33), and a group which received no psychological counselling (MC, n=33). They were compared to a control group of 61 women who received no specific postmiscarriage counselling. All participants completed preintervention and postintervention measures and 4-month follow-up questionnaires.


RESULTS
The scores on the outcome variables decreased significantly with time for all three groups. In group MPC, compared to controls, there was a significantly greater decrease over time in the levels of grief, self-blame, and worry and, compared to MC group, a significantly greater decrease in grief and worry. In group MC, compared to controls, there was a significantly greater decrease in self-blame. In the MC and MPC groups, those with an identified cause of the miscarriage had significantly lower levels of anxiety and self-blame over time than those with a nonidentified cause.


CONCLUSIONS
Psychological counselling, in addition to medical investigations and consultation, is beneficial in reducing women's distress after miscarriage. However, absence of an identifiable cause of miscarriage led to the maintenance of the initial anxiety levels, which should have otherwise decreased with time.
Nikcević
Ana V
AV
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical, School, London, United Kingdom. a.nikcevic@kingston.ac.uk
Kuczmierczyk
Andrzej R
AR
Nicolaides
Kypros H
KH
D000030:Abortion, Missed / Q000209:etiology / Q000523:psychology*; D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D003376:Counseling; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006117:Grief; D006167:Guilt; D006801:Humans; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D011795:Surveys and Questionnaires