Counsellors have a major role to play in helping women who because of ectopic pregnancies or early pregnancy loss can help combat their anxiety and distress or post traumatic stress which can continue for many months beyond the support offered by health services.
Many women are driven to self-harm or thoughts of suicide when faced when feeling totally alone in such situtations. A professional counsellor can stretch offer empathy to show they are not alone in their darkest hours when new life has been snatched away.
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.
Strengths and limitations of this study
We have used validated instruments to obtain quantitative data on mental well-being after early pregnancy loss.
We have included women who have suffered both miscarriages and ectopic pregnancies.
In addition to anxiety and depression we have tested for the probable presence or absence of post-traumatic stress disorder.
The main limitation of this study was the dropout rate for responses at 1 month and in our control group.
While it is a strength that we have included a control group, a potential weakness is that these were women who were attending an early pregnancy unit for assessment.