Follow-up for improving psychological well being for women after a miscarriage

Miscarriage is the premature, or loss of a fetus, up to 23 weeks of pregnancy. Some women suffer from anxiety and depression after miscarriage which may be part of their grief following the loss. Psychological follow-up might detect those women who are at risk of psychological complications following miscarriage. This review of six studies, involving 1001 women, found that there is insufficient evidence from randomised controlled trials to recommend any method of psychological follow-up. Timing of the counselling interventions varied from one week following miscarriage up to 11 weeks. In all studies the interventions were delivered by different professional groups including a midwife, psychologists and nurses. Measurements of the outcomes were made from one month to 12 months after miscarriage in the different studies, which highlights the uncertainty surrounding the rate of psychological recovery following miscarriage. The two larger studies included a complex combination of interventions and outcome measures so that any potentially significant effects may have been diluted.

Further robust research is needed to determine if any recognised psychological follow-up is effective is hastening psychological recovery following miscarriage.

Authors' conclusions: 

Evidence is insufficient to demonstrate that psychological support such as counselling is effective post-miscarriage. Further trials should be good quality, adequately-powered using standardised interventions and outcome measures at specific time points. The economic implications and women's satisfaction with psychological follow-up should also be explored in any future study.

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Background: 

Miscarriage is the premature expulsion of an embryo or fetus from the uterus up to 23 weeks of pregnancy and weighing up to 500 grams. International studies using diagnostic tools have identified that some women suffer from anxiety, depression and grief after miscarriage. Psychological follow-up might detect those women who are at risk of psychological complications following miscarriage. This review is necessary as the evidence is equivocal on the benefits of psychological follow-up after miscarriage.

Objectives: 

Whether follow-up affects the psychological well being of women following miscarriage.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2011), reference lists of all retrieved papers and contacted professional and lay organisations to obtain any ongoing trials or unpublished data.

Selection criteria: 

Randomised controlled trials only.

Data collection and analysis: 

All potential trials for eligibility according to the criteria specified in the protocol by screening the titles and abstracts, retrieving full reports of potentially relevant trials for assessment. All review authors extracted data and checked for accuracy. No studies were published in duplicate. When data were missing and only the abstract was available, we attempted to contact the trial authors. We resolved any disagreement through discussion.

Main results: 

Six studies involving 1001 women were included. Three trials compared one counselling session with no counselling. There was no significant difference in psychological well being including anxiety, grief, depression avoidance and self-blame. One trial compared three one-hour counselling sessions with no counselling at four and 12 months. Some subscales showed statistical significance in favour of counselling and some in favour of no counselling. The results for two trials were given in narrative form as data were unavailable for meta-analyses. One trial compared multiple interventions. The other trial compared two counselling sessions with no counselling. Neither study favoured counselling.

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