A 1 and 6 month follow-up of prenatal diagnosis patients who lost pregnancies

Abstract

This paper reports results of an exploratory study of prenatal diagnosis patients who experienced voluntary terminations of pregnancy following the detection of an abnormality or spontaneous miscarriages. The 121 participants were part of the national collaborative Chorionic Villus Sampling and Amniocentesis Study. They completed semi-structured telephone interviews and mailed questionnaires at 1 month and 6 months after the pregnancy losses. Scores on the Profile of Mood States showed that mood levels improved significantly over time. However, there were some declines in loss-related support from partners and others. The persisting distress and difficulties of a minority highlight the variability in women's responses to pregnancy losses. Women who lost pregnancies later in gestation, showed the greatest mood disturbances at initial assessments, used professional mental health assistance after the loss, or reported less satisfactory loss-related support from significant others showed the greatest levels of mood disturbance at the six-month assessment. Follow-up contacts with patients who lose pregnancies should be used to inform women about the variation in possible grief reactions, to assess the extent of support the women are receiving from their partners and significant others, and to provide additional follow-up or referral of those experiencing the greatest distress.

PIP: Obstetrician-gynecologists from the University of Virginia in Charlottesville and Wayne State University/Hutzel Hospital in Detroit, Michigan, present an ethical justification for fetal intracardiac potassium chloride injection to bring about cardiac arrest prior to induction of labor. Some pregnant women do not become aware of fetal anomalies until the 2nd trimester. Some of these fully informed and capable women opt to terminate the pregnancy. Yet late 2nd trimester abortions sometimes result in the delivery of a live neonate. This poses an ethical dilemma for the physician who performed the abortion, the neonatologist, and the woman who chose to abort and affected fetus. Specifically, neonatologists intervene to save an aborted neonate. The physician ethicists propose that the individual rights of a woman (and the biological father, if available and involved) should protect her from interference from others in relation to a legal abortion. If injected intracardiac potassium chloride cardiac arrest killing the fetus indeed protects the choices of the woman and perhaps even an involved biological father from interference and coercive imposition of treatment, then intracardiac injection is justified. Injection has the same result as would the abortion process itself had extrauterine death occurred. In addition to protecting the woman's right to noninterference and prevention of coercive actions by other health care personnel, fetal intracardiac potassium chloride injection also prevents the psychological damage the woman and her family would most assuredly suffer if the abortus/neonate lives through the abortion. Fetal killing, be it by dilation and evacuation or direct intracardiac potassium chloride, poses significant stress to the involved health care workers. Physicians should perform this procedure only in the event there is high probability of an unjustified intervention by health personnel.