BEREAVEMENT, GRIEVING AND PSYCHOLOGICAL MORBIDITY AFTER FIRST TRIMESTER SPONTANEOUS-ABORTION - COMPARING EXPECTANT MANAGEMENT WITH SURGICALEVACUATION

Early pregnancy loss is a profound adverse life event for many women, and increased psychiatric morbidity has been shown to occur after spon taneous abortion. Dilatation and curettage (D&C) has been the cornerst one in the treatment of first trimester spontaneous abortion over the last few decades, During recent years the possibility of conservative management has, however, been increasingly discussed. In a prospective randomized trial, we compared psychological reactions and morbidity, after either expectant management or D&C, for miscarriages of <13 week s gestation in which a transvaginal ultrasound examination showed intr auterine tissue and/or blood clots with an antero-posterior diameter o f between 15 and 50 mm. Of the 86 patients included, 58 were randomize d to expectant management and 28 to primary D&C. In patients randomize d to expectant management, pregnancy products shown by transvaginal ul trasound disappeared within 3 days in 43 cases (74%), whereas 15 patie nts (26%) underwent D&C owing to retained products of conception after 3 days. At 2 weeks after inclusion, all patients answered self-admini stered questionnaires, including visual analogue scales, concerning th eir experience of the pregnancy loss, the present situation and concer ns about the future. A brief anxiety status inventory was included. Th is study showed no increase in anxiety or depressive reactions 2 weeks after a first trimester spontaneous abortion when these patients were compared with non-pregnant healthy working females 19-39 years of age . Moreover, there were no significant differences in psychological rea ctions between patients managed either expectantly or by D&C.