RESUMO
Objective: To evaluate the psychological aspect of subfertility and treatment on the couples. Methodology: This Prospective survey study was carried out in the department of Obstetrics and Gynaecology at a private hospital in Lahore, Pakistan. 40 couples undergoing fertility treatment were enrolled. A Self-report questionnaire included age, level of education, social status, duration of marriage , duration of infertility, causes of infertility, duration of treatment, social stress, effect of infertility on marital relationship, expected likelihood of achieving pregnancy, anticipation of stress during treatment, and emotional reactions to infertility was given to all the participants of the study
Results: The majority [70%] of women undergoing fertility treatment were of ages 25-34 years. 62.5% couples were married for 1 to 5 years. Majority of couples were educated and belonged to the middle-class family. 55% had been undergoing treatment for 3 years and more. In half, the causes of infertility were known. 67.5% had failed treatment and 32.5% became pregnant with treatment. All the couples experienced emotional trauma with treatment and needed psychological help despite the outcome. 62.5% suffered with depression, 30% anxiety and 7.5% had anger. 15% women needed psychiatric medication besides counselling and behavioural therapy. 60% couples had sexual dysfunction leading to marital problems. 80% couples complained of behaviour changes. Specific questionnaires were structured for assessing different psychological aspects on infertile women, men or couples. The hospital Anxiety and Depression Scale and demographic and fertility information questionnaire was given to all infertile couples. The psychological impact was more on females 82.5% compared to males 17.5%. All the couples underwent social pressure
Conclusions: Psychological factors play an important role in the infertility. It is important to manage this devastating problem, which has cultural and social impact
RESUMO
Objectives: To evaluate the risk factors in women with pregnancies affected by stillbirth and the management in subsequent pregnancies. Design: Retrospective study. Setting: District General Hospital. Population: 65 women were identified having had a stillbirth
Methodology: This is a retrospective study over 4 years in East Sussex Healthcare Trust. The inclusion criteria were stillbirths after 24 weeks of gestation. The exclusion criteria were twin pregnancy with single fetus demise under 24 weeks. The demographic details, predisposing risk factors, body mass index, and details of the baby were collected and analysed. Main outcome measures. Maternal and fetal risk factors
Results: Sixty five women were identified for the study [0.4% of all deliveries] out of which 62 case notes [95.4%] were retrieved. The ethnic distribution were [87%] Caucasian, [8%] Black Africans, [2%] Asians and 3% were unknown. Primigravida [38%] had a higher rate of stillbirth. In 58% the booking BMI was <30, 11% were obese and in 31% not recorded. In 61% there was an identifiable risk factor. Almost one third of the women [30%] smoked. In only 76% of the cases post-mortem examination was performed out of which 25.8% had no pathology
Conclusions: Loss of a baby can be extremely distressing to the couple as well as to the health care provider involved in her care. Close antenatal surveillance with adequate emotional support is the cornerstone in management of these women as recent CEMACH report identified suboptimal intrapartum care in 40-75% of cases