Treatment choice for miscarriage: an evaluation of the psychological impact for women and their partners
Creators: name: Kyte, Zoe Amelia
Publisher: name: University of Lincoln
Year: 2024
Subjects: C800 - Psychology

description: Background: Currently, standard practice is to allocate women to a particulartreatment for miscarriage; most commonly surgical. The alternative of offeringwomen a choice in their treatment is controversial due to pre-conceptionsaround their potential for distress. However, exploration of the psychologicaloutcomes of women and their partners when given a choice may offer newinsights into the validity of existing ideas.Methods: A non-randomised longitudinal design was used. Eighty-onewomen attending an Early Pregnancy Assessment Unit completed a 14-daydiary following their miscarriage, including factors contributing to theirtreatment choice, the General Health Questionnaire (GHQ-12), theSpielberger Trait Anxiety Inventory (STAI), and rating scales for pain andbleeding. Women and their partners were also sent follow-up questionnairesat six weeks, including the GHQ-12, the Impact of Events Scale (IES) andevaluation of their treatment. Quantitative data was analysed using nonparametricanalysis due to data not conforming to gaussian distributions andunequal sample sizes across treatment groups. Analyses included WilcoxonSigned Rank tests to explore changes over time on specific measures,Kruskal Wallis tests to explore differences between treatment groups, MannWhitney Tests to locate specific post-hoc group differences, and chi-squaretests to examine treatment choices and factors affecting choice. This analysiswas complimentary to further qualitative theme analysis of additional factorswomen freely described as important when making their choice in treatment.2008 Research Project Report. UoL: 06060037, UoN: 4059140 Page 8 of 233Results: 43.2% of women chose surgical treatment, with choice beinginfluenced by being frightened of seeing the miscarriage. Different factorswere influential to women’s choices across the other treatment options.Women expressed a range of factors that contributed to their choice, includingdesire for a speedy return to normality, past experience, desire for the mostnatural option, family and home support, impact on family, staff advice, fear ofpain, bleeding and complications, wanting to avoid hospital, wanting control,and seeking an explanation for their miscarriage. STAI and GHQ-12 scoresdid not significantly differ according to treatment choice. Levels of pain alsofailed to discriminate between the treatment groups. However, womenreceiving expectant treatment reported greater amounts of bleeding acrossdays one to four compared to those receiving surgical treatment. Furthermore,scores on the IES were significantly different across groups, with the medicaloutpatient group reporting lower scores than all others, and the surgical groupreporting lower scores compared to the medical inpatient group. Scoresacross all measures were not significantly different when women and theirpartners were compared, although a significantly greater proportion ofpartners reached “caseness” on the GHQ-12 in the group of women receivingsurgical treatment,Conclusions: The largest proportion of women chose surgical as theirpreferred treatment, with different choices being influenced by differentfactors. Whilst anxiety and non-psychotic symptoms do not appear to differdepending on the treatment women received, results suggest those womenchoosing medical outpatient experienced less trauma as a result compared to2008 Research Project Report. UoL: 06060037, UoN: 4059140 Page 9 of 233all other treatment groups. This was also true but to a lesser extent for womenchoosing surgical treatment (who also reported lower levels of bleedingcompared to those receiving expectant treatment). Across measures, whilstthe level of psychological distress was comparable between women and theirpartners, men appeared to experience greater distress when their partner hadreceived surgical treatment.