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Miscarriage and ectopic pregnancy may trigger PTSD

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Women may be at risk of experiencing post-traumatic stress disorder, following a miscarriage or ectopic pregnancy, according to a UK study.

Researchers from Imperial College London said their findings suggested women should be routinely screened for the condition, and receive specific psychological support following pregnancy loss.

“We were surprised at the high number of women who experienced symptoms of PTSD”

Jessica Farren

They surveyed 113 women who had recently experienced a miscarriage or ectopic pregnancy, asking about their thoughts and feelings after their pregnancy loss.

All of the women had attended the Early Pregnancy Assessment Unit at Queen Charlotte’s and Chelsea hospital in West London.

The majority of participants had suffered a miscarriage in the first three months of pregnancy, while around 20% had suffered an ectopic pregnancy – where the baby starts to grow outside the womb.

The results, published in the journal BMJ Open, revealed that 38% of women reported symptoms consistent with probable post-traumatic stress disorder three months after the pregnancy loss.

Among the women who suffered a miscarriage, 45% reported PTSD symptoms at this time, compared to 18% of the women who suffered an ectopic pregnancy.

PTSD symptoms can start weeks, months or even years after a traumatic event and can cause sleeping problems, anger, and depression.

“We are now investigating why some women may be more at risk than others”

Tom Bourne

The study participants who met criteria for PTSD reported regularly re-experiencing feelings associated with the pregnancy loss, and having intrusive or unwanted thoughts about it.

Some women also reported having nightmares or flashbacks, while others avoided anything that might remind them of their loss, or friends and family who are pregnant.

Furthermore, nearly a third said their symptoms had impacted on their work life, and around 40% reported their relationships with friends and family had been affected.

Lead study author Dr Jessica Farren said the findings suggested that women affected by pregnancy loss should have an opportunity to discuss their emotions with a health professional.

“We were surprised at the high number of women who experienced symptoms of PTSD after early pregnancy loss,” she said.

“At the moment there is no routine follow-up appointment for women who have suffered a miscarriage or ectopic pregnancy,” she said. “We have checks in place for postnatal depression, but we don’t have anything in place for the trauma and depression following pregnancy loss.

“Yet the symptoms that may be triggered can have a profound effect on all aspects of a woman’s everyday life, from her work to her relationships with friends and family,” she noted.

Dr Farren highlighted that previous research had suggested women who experienced a stillbirth may develop PTSD, but the new study was the first to only focus on early pregnancy loss.

“There is an assumption in our society that you don’t tell anyone you are pregnant until after 12 weeks. But this also means that if couples experience a miscarriage in this time, they don’t tell people,” she said. “This may result in the profound psychological effects of early pregnancy loss being brushed under the carpet, and not openly discussed.”

Imperial College London

Miscarriage and ectopic pregnancy may trigger PTSD

Tom Bourne

Senior study author Professor Tom Bourne said larger follow-up studies were now being planned to confirm the findings and help clinicians identify at-risk women.

“Not all women who suffer a miscarriage or an ectopic pregnancy will go on to develop PTSD or anxiety and depression,” he said. “Therefore, we are now investigating why some women may be more at risk than others.”

Professor Bourne added that in addition to improving diagnosis of psychological disorders following miscarriage, researchers needed to assess what treatments may help.

“We know that talking therapies, such as cognitive behavioural therapy, have been successful at treating PTSD,” he said. “However, we need to investigate how this treatment should be tailored to women who have suffered an early pregnancy loss.”

The research was funded by the Imperial College Healthcare Charity, the charity Tommy’s, and the National Institute of Health Research Imperial Biomedical Research Centre.

“There must now be added impetus to change miscarriage treatment and care”

Jane Brewin

Ian Lush, chief executive of the Imperial charity, said: “We recognised early on the potential this piece of research had, and equally, how important the findings would be to patients and clinical staff right across the NHS.”

Jane Brewin, chief executive of Tommy’s, added: “There must now be added impetus to change miscarriage treatment and care.

“Many women need more support following a miscarriage and the NHS needs to rethink how women are treated throughout the experience so they do not suffer from PTSD and other psychological impacts,” she said.

Miscarriage affects one in four pregnancies in the UK. Ectopic pregnancies are much rarer, affecting around one in 90 pregnancies.

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Readers' comments (1)

  • Totally agree, and many of those women could also be assessed for reasons for miscarriage such or sticky blood syndrome (otherwise known as Antiphospholipod syndrome or Hughes syndrome). They should ask to be tested if they have miscarried twice and monitored in subsequent pregnancies. They may need special treatment to help preserve their pregnancies and it may even help prevent Stroke in young females. Not to say that this may also help prevent stroke later in life.
    Just wish that more Drs are made aware of this syndrome, especially GPS as they erew the Drs who would usually hear about the miscarriages.
    I totally agree about PTSD because I have worked in the community as a midwife many years ago and we were the ones usually called to see that Mum at home. Nowadays there are so few community midwives. They are no longer GP attached and therefore the continuity of care stops. Maybe some hope if there are any Health visitors, if the Mum has older children, but there is no longer any multi disciplinary team to communicate with. Were the old days better? Then I would say Yes. We were GP based, we had GPS, Midwives, District Nurses, Health Visitors and Social Workers. We had a common room for meeting, and lunch time unless I was out delivering a baby I had people who knew the families or who became involved with the people who saw the group practice GP. We were a team and a good one at that. But that was over 40 years

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