Psychosocial needs of women during miscarriage or ectopic pregnancy

Reduced prevalence of chronic tubal inflammation in tubal pregnancies after levonorgestrel emergency contraception failure

PURPOSE

The aim of this study was to compare chronic fallopian tubal inflammatory disease and fibrosis between patients with general tubal pregnancy (TP) and TP with levonorgestrel (LNG) emergency contraception (EC) failure.

METHODS

We retrospectively studied patients with general TP (n = 79) and TP following LNG-EC failure (n = 81) within the same conception cycle. Information on the gynecological features of each subject was collected. Pelvic inflammatory disease and associated sequelae were assessed by the serum Chlamydia trachomatis (CT) IgG test, laparoscopic evaluation of tubal damage, and histopathological observation of tube tissues. Chi-square and Student's t-tests were employed to determine the difference between the two groups.

RESULTS

Compared with general TP, cases of TP following LNG-EC failure subjects were less likely to have a history of previous ectopic pregnancy (5.06% vs. 18.52%, p = 0.009) and adnexal surgery (6.33% vs. 22.22%, p = 0.010). Patients with TP following LNG-EC failure were less likely to have pelvic inflammatory disease and associated sequelae than those with general TP, as revealed by positive reaction to anti-CT IgG (18.18% vs. 35.94%, p = 0.031), assessment of tubal damage (grade I: 5.06% vs. 17.28%; grade II: 2.53% vs. 11.11%; grade III: 1.27% vs. 6.17%; p = 0.001), infiltration of chronic inflammatory cells (10.91% vs. 62.50%, p < 0.001), and positive Masson's staining (7.69% vs. 39.58%; p < 0.001).

CONCLUSIONS

Compared with cases of general TP, cases of TP following LNG-EC failure exhibited reduced rates of CT infection, fallopian tubal inflammation, and/or fibrosis.

The impact of previous perinatal loss on subsequent pregnancy and parenting

The loss of any pregnancy through miscarriage, ectopic pregnancy, stillbirth, or neonatal death presents as a significant life crisis for any woman and has far-reaching implications into a couple's future aspirations. Planning another pregnancy after dealing with a perinatal loss is difficult and plagued by ambivalence, doubts, and insecurities. Despite this ambivalence, a majority of women do become pregnant within a year following a perinatal loss. Four recurring issues surrounding perinatal loss and subsequent pregnancy have been identified in this literature review: the effect of the grief process on the subsequent pregnancy; parental coping mechanisms during the subsequent pregnancy; replacement or vulnerable child syndrome; and parenting issues with the subsequent live-born child. Issues surrounding anxiety as a coping mechanism during a pregnancy following a perinatal loss are documented consistently in the literature; however, less is known about the impact that a loss has on parenting behaviors with subsequent children. Further research is imperative to examine these issues in more detail so that evidence-based practices can be established and updated. Health care providers are in a unique position to assist these couples in dealing with the issues that a perinatal loss may place on subsequent pregnancies. By providing a reassuring and supportive environment, women can achieve a positive pregnancy outcome with the correct tools to decrease anxiety and enhance attachment to the subsequent healthy child.

Pregnancy loss: what it means to women who miscarry and their partners

This paper reports results from six women who had miscarried and their partners in Melbourne. A qualitative approach, namely in-depth semi-structured interviews, was utilised to obtain information. Several themes emerged from the data. The findings of this study show that women and men experienced a variety of feelings in reaction before, during and after the miscarriage. These feelings varied in type, intensity, and duration in which the men generally experienced less intense feelings for a shorter period of time as compared to the women. We argue that support and counselling be provided not only for women who miscarry, but also for their male partner, as the men may have fewer means to express their grief due to the "social expectation" of male roles.

Nursing management in the accident and emergency department of women undergoing a miscarriage

Women experiencing a miscarriage are a regular daily occurrence in some Accident and Emergency (A & E) departments. Each woman's miscarriage experience is unique and individual and women deserve an individual response to their problems, one that is built on trust and communication. Therefore, emergency nurses must appreciate that each woman is an individual and must explore the history she brings to the current event, the meaning she attributes to the miscarriage, and its impact on her life. These women need to be cared for in an environment that not only allows privacy but also respect and dignity. Nurses need to be able to communicate effectively, to give good physical care and be willing to take on the emotional significance that miscarriage can have. This paper aims to explore the needs of the woman experiencing a miscarriage. It attempts to look at what emergency nurses can do to meet those needs, and what can be done to make this difficult time as tolerable as possible for the woman or couple, when they present to the A & E department.