Psychological impact of Early Miscarriage and client satisfa
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A Study was conducted to compare short and long term emotional distress (grief, anxiety, depressive symptoms) after early miscarriage in women randomized to expectant management or misoprostol treatment, and to compare satisfaction with treatment. If the miscarriage was not complete on day 31 after inclusion, surgical evacuation was recommended.

Main outcome measures were grief, anxiety, depressive symptoms and client satisfaction assessed by validated psychometric self-assessment instruments, i.e. Perinatal grief scale (PGS), Spielberger State Trait Anxiety Inventory (STAI S Form Y), Montgomery asberg Depression Rating Scale Self report version (MADRS S) and Client Satisfaction Questionnaire (CSQ 8).

There were four assessment points: the day of randomization, the day when the miscarriage was judged to be complete, and 3 months and 14 months after complete miscarriage. Analysis was by intention to treat.

--90 women were randomized to expectant management and 94 to misoprostol treatment.

--The psychometric and client satisfaction scores were similar in the two treatment groups at all assessment points.

--At inclusion, 41% of the women managed expectantly and 37% of those treated with misoprostol had STAI state scores more than 46 and 9% and 10% had symptoms of moderate or severe depression.

--In both treatment groups, symptom scores for anxiety and depression were significantly higher at inclusion than after treatment and remained low until 14 months after complete miscarriage. Grief reactions were mild.

--The median PGS score in both treatment groups was 40.0 at 3 months and 37.0 at 14 months after complete miscarriage.

--4 women treated with misoprostol and two women managed expectantly had PGS scores more than 90 (indicating deep grief) 3 months after complete miscarriage. 1 woman managed expectantly had PGS score more than 90 after 14 months.

Women treated with misoprostol and those handled expectantly had similar psychological reactions to and recovery from early miscarriage. Treatment satisfaction was high in all treatment classes. These results suggest that patients should be involved in the decision-making process when it comes to early miscarriage care.