This cross-sectional study of 204 women who had experienced a missed abortion, diagnosed at 10-14 weeks of pregnancy, examined the availability and desirability of routine follow-up care, and whether such care is associated with reduced psychological morbidity in the aftermath of miscarriage. Clinically elevated anxiety and depression were observed in 45% and 15% of women, respectively, and the mean score of grief was 2.52 which is similar to that observed in people who suffer death of a close relative. A follow-up appointment after the miscarriage was thought to have been desirable by 92% of women but was offered to only 30%. No significant association between such care and reduced psychological morbidity was identified. However, there were significantly more women with clinically elevated levels of anxiety among those who felt that they were not provided with an opportunity to discuss their feelings during the follow-up, suggesting that such a follow-up either had a deleterious effect on women's psychological state or the distress itself led to such a perception of care. One-third of women in our sample would have liked psychological counselling to help them deal with the emotional aspects of their loss.
PIP: The 10-14 week ultrasound scan has been introduced to routine prenatal care for early diagnosis of major defects and screening for chromosomal abnormalities. In about 3% of such scans, the diagnosis of missed abortion is made. Despite evidence of substantial emotional stress associated with early pregnancy loss, follow-up care is not routinely provided. The present study investigated the availability and effectiveness of such follow-up care in 204 women (median age, 36 years) from London, England, who received a diagnosis of missed abortion or anembryonic pregnancy at 10-14 weeks of gestation in 1995-96. At the time of the survey, 19-400 days after the ultrasound, clinically elevated anxiety and depression were observed in 45% and 15% of women, respectively. The mean grief score was 2.52, which exceeded that reported in another study of persons who suffered the death of a close relative (2.23). 187 women (92%) expressed the belief a follow-up appointment after diagnosis would have been desirable; 73 (36%) thought they would have benefited from emotional counseling. However, a follow-up appointment was offered to only 61 women (30%). Even among women offered a follow-up visit, 22 (42%) indicated they were not provided an opportunity to discuss their feelings about the miscarriage. Women who attended the follow-up but felt they were not given an opportunity to express feelings had significantly higher mean anxiety and depression scores than women who did not have follow-up care or those who attended the follow-up and discussed their feelings. Overall, these findings indicate that miscarriage and the evacuation of retained products of conception are traumatic experiences that are too often dismissed as routine by medical staff.