The psychosocial sequelae of a second-trimester termination of pregnancy for fetal abnormality

Abstract

A retrospective study to investigate the psychosocial sequelae of a second-trimester termination of pregnancy (TOP) for fetal abnormality (FA) is described. After appropriate consent was obtained, 84 women and 68 spouses were visited 2 years after the event and asked to complete an extensive questionnaire. Most couples reported a state of emotional turmoil after the TOP. There were differences in the way couples coped with this confusion of feelings. After 2 years about 20 per cent of the women still complained of regular bouts of crying, sadness, and irritability. Husbands reported increased listlessness, loss of concentration, and irritability for up to 12 months after the TOP. In the same period, there was increased marital disharmony in which 12 per cent of the couples separated for a while and one couple obtained a divorce. These problems could be attributed to a lack of synchrony in the grieving process. Confusing and conflicting feelings led to social isolation and lack of communication. Difficulties in coming to terms with the fetal loss were not found to be linked to the type of fetal abnormality or religious beliefs but were related to parental immaturity, inability to communicate needs, a deep-rooted lack of self-esteem before the pregnancy, lack of supporting relationships, and secondary infertility. Suggestions for improved management are given.

PIP: 84, or 87% of all women from West Scotland who had second trimester termination of pregnancy for fetal abnormalities in 1986, and 68 spouses, participated in a study of psychosocial sequelae. A structured questionnaire was administered during a home visit 2 years after the termination. Gestations ranged from 12 to 27 weeks (median 19). The women's ages ranged from 17 to 46 years (median 27), that of their partners was 17-48 (median 29). Indications for the abortions were tabulated. Only 5% of the women were without partners. 15% were unemployed. 33% of the pregnancies were the couples' 1st. 76% of the abnormal pregnancies were directed by the West of Scotland Alpha-fetoprotein screening program. 72% of the pregnancies had been planned, 26% had been unplanned but were welcome, and only 2% of women were still ambivalent. 2 couples regretted their decision. At 2 years 20% of women were having crying spells, sadness, and irritability. Husbands reported listlessness, poor concentration, and irritability up to 1 year afterward. 12% of couples marital problems resulting in separation of 2% and 1 divorce. Physical symptoms such as palpitations and panic attacks were only reported by those under 25. 1 woman and 1 man required in-patient treatment; 11 women received counseling; 5 took anti depressants. 3 men had counseling and 3 took antidepressants. A majority of men reported confusing and conflicting reactions to their wives' feelings which may have led to social isolation and lack of communication. 55% of the women and 58% of the men said they had not discussed their feelings with anyone. There were no specific psychological sequelae linked to specific fetal abnormalities or religious beliefs. Immaturity, inability to communicate needs, low self-esteem, lack of social support, and secondary infertility all were associated with dysfunctional grieving. It was concluded that such grief and emotional turmoil could be shortened by skilled preparatory counseling.