Stress, anxiety, intolerance of uncertainty, and psychological well-being characteristics of pregnant women with and without threatened miscarriage: a case-control study.

The aim of this study was to examine the stress, anxiety, intolerance of uncertainty, and psychological well-being of pregnant women with and without threatened miscarriage. This is a case-control study. The research was carried out between January 2022 and March 2022 in the early pregnancy service and obstetrics clinic of the only training and research hospital in a province in the Central Anatolian Region of Turkey. Two hundred and one pregnant women with threatened miscarriage constituted the study group and 201 pregnant women without threatened miscarriage constituted the control group. A total of 402 pregnant women were included in the study. Stress, anxiety, and intolerance of uncertainty were found to be important risk factors affecting the psychological well-being of pregnant women with threatened miscarriage at a rate of 52% (F = 63,196, p < 0.001). In addition, the pregnant women with threatened miscarriage had higher levels of stress, anxiety, and intolerance of uncertainty, and their psychological well-being was considerably lower compared to pregnant women without threatened miscarriage (p < 0.05). There was a moderate and negative relationship between psychological well-being and intolerance of uncertainty (p < 0.05). It was determined that stress, anxiety, and uncertainty of pregnant women with threatened miscarriage were considerably higher compared to controls, and their psychological well-being was adversely affected. Health professionals should evaluate the levels of anxiety, stress, intolerance of uncertainty, and psychological well-being of pregnant women, especially in the routine follow-up of pregnant women with threatened miscarriage, and they should provide holistic care, not only physiologically but also bio-psychosocially.IMPACT STATEMENTWhat is already known on this subject? Although there are many studies on the emotional and psychological effects of miscarriage, there are limited studies on the effect of threatened miscarriage on the mental health of pregnant women.What do the results of this study add? Stress, anxiety, and intolerance to uncertainty were found to be important associated risk factors that negatively affect the psychological well-being of pregnant women with threatened miscarriage. It was determined that the pregnant women with threatened miscarriage had higher levels of stress, anxiety, intolerance to uncertainty, and their psychological well-being was much lower than the pregnant women without threatened miscarriage. It was determined that there was a moderate and negative relationship between the mean psychological well-being of pregnant women and the mean scores of intolerance to uncertainty.What are the implications of these findings for clinical practice and/or further research? This is the first case-control study to examine the determination of stress, anxiety, intolerance to uncertainty and psychological well-being of pregnant women with and without threatened miscarriage. Health professionals should evaluate the anxiety, stress, intolerance of uncertainty levels and psychological well-being of pregnant women, especially in the routine follow-up of risky pregnant women, and should provide holistic care not only physiologically but also bio-psychosocially to these pregnant women with a holistic approach.

Psychological problem areas of pregnant women diagnosed with abortus imminens as a result of assisted reproductive techniques: A comparative study.

PURPOSE: The study was to evaluate the anxiety, depressive symptoms, hopelessness, and perceived social support of women who became pregnant using assisted reproductive techniques and who were both diagnosed or not diagnosed with threatened miscarriage (TM). DESIGN AND METHODS: This comparative and descriptive study was carried out with 194 pregnant women with-TM (96) and non-TM (98). The study data were collected using the Pregnant-Women-Information-Form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS) and Multidimensional Scale of Perceived Social Support (MSPSS). FINDINGS: Women in the TM group were found to have higher mean scores from the BDI, BAI, and BHS, and a lower mean score from the MSPSS compared to the non-TM group (The group with TM had higher levels of anxiety, depression, and hopelessness than the group without TM, and the level of perceived social support by this group was lower). It was found that there was a strongly significant positive correlation in both groups between the BDI and BAI, and between the BDI and BHS. A strongly significant negative correlation was found between the BDI, BAI, BHS, and MSPSS in the TM group, whereas there was a moderately significant negative correlation in the non-TM group. It was found that there was a statistically significant difference between the mean BDI, BAI, BHS, and MSPSS scores according to age group, educational status, number of interventional in vitro fertilization attempts, and history of depression. In addition, there was a statistically significant difference between the mean BDI, BAI, and BHS scores according to previous abortion and family history of depression in the TM group. PRACTICE IMPLICATIONS: Monitoring symptoms of depression, anxiety, and hopelessness in women diagnosed with TM who have become pregnant after infertility treatment, intervening due to the risk factors involved, may prevent possible mental problems and have a positive impact on the healthy continuation of the pregnancy.

Threatened preterm labour: Women's experiences of risk and care management: A qualitative study.

BACKGROUND: Preterm birth is a major cause of neonatal death and severe morbidity, so pregnant women experiencing symptoms of threatened preterm labour may be very anxious. The risk assessment and management that follows recognition of threatened preterm labour has the potential to either increase or decrease this anxiety. The aim of this study was to explore women's experience of threatened preterm labour, risk assessment and management in order to identify potential improvements in practice. DESIGN: One-to-one semi-structured interviews with 19 women who experienced assessment for threatened preterm labour took place between March 2015 and January 2017. A purposive sample approach was employed to ensure participants from different risk and demographic backgrounds were recruited at an inner city UK NHS hospital. Interviews were recorded and transcribed. Data was managed with NVivo software and analysed using the Framework Approach. A public and patient involvement panel contributed to the design, analysis and interpretation of the findings. FINDINGS: Data saturation was achieved after 19 interviews. 11 women were low risk and 8 were high risk for preterm birth. All high risk women had experience of being supported by a specialist preterm team. Four main themes emerged: (i) coping with uncertainty; (ii) dealing with conflicts; (iii) aspects of care and (iv) interactions with professionals. Both low and high risk women experiencing TPTL struggle to cope with the uncertainty of this unpredictable state. The healthcare management they receive can both help and hinder their ability to cope with this extremely stressful experience. High risk women were less likely to receive conflicting advice. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Clinicians should acknowledge uncertainty, minimize conflicting information and advice, and promote continuity of care models for all women, including those attending high risk clinics and in the ward environment.

Threatened miscarriage and depressive and anxiety symptoms among women and partners in early pregnancy.

BACKGROUND: Antenatal depression has been associated with poor maternal and fetal outcomes, and threatened miscarriage is often seen clinically to impact adversely on maternal wellbeing, notwithstanding the limited research evidence. Our study aims to examine the link between threatened miscarriage and antenatal depression and anxiety in an Asian obstetric population. METHODS: We recruited 121 women and 68 partners facing threatened miscarriage, and 241 women and 180 partners experiencing uncomplicated pregnancies from a tertiary maternity hospital in Singapore. All participants completed a Patient Information Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: The proportion of women with major depressive and anxiety symptomatology was significantly higher among women facing threatened miscarriage compared to those with stable pregnancies (depressive: 33.1% vs. 17.0%, p = 0.008; anxiety: 48.8% vs. 23.7%, p < 0.0001). Amongst their partners, there was a non-significant trend towards a similar finding (depressive: 10.3% vs. 7.2%, p = 0.439; anxiety: 23.5% vs. 18.9%, p = 0.478). Threatened miscarriage remained significantly associated with major depressive symptomatology after adjusting for potential confounders among women (OR 2.70; 95% CI 1.55, 4.71; p < 0.0001) but not among their partners (OR 1.47; 95% CI 0.56, 3.87; p = 0.430). LIMITATIONS: This study is limited by its cross-sectional design and relatively small sample size for male partners. CONCLUSION: Antenatal depressive and anxiety symptomatology affects one in four women in their first trimester, with even higher prevalence among women facing threatened miscarriage. Targeted depression and anxiety screening that includes women facing threatened miscarriages may facilitate early and efficient detection and management of mental health problems among pregnant women.

Does acupuncture have a role in the treatment of threatened miscarriage? Findings from a feasibility randomised trial and semi-structured participant interviews.

BACKGROUND: Threatened miscarriage is a common complication of early pregnancy increasing the risk of miscarriage or premature labour. Currently there is limited evidence to recommend any biomedical pharmacological or self-care management, resulting in a 'watchful waiting' approach. The objective of this study was to examine the feasibility of offering acupuncture as a therapeutic treatment for women presenting with threatened miscarriage. METHODS: A mixed methods study involving a randomised controlled trial and semi structured interviews. A pragmatic acupuncture protocol including medical self-care advice was compared to an active control receiving touch intervention and medical self-care advice. Descriptive statistics were used to examine the demographic and baseline characteristics. Endpoints were analysed between groups using a mean t-test and chi-square tests with P < 0.05 considered statistically significant. Dichotomous data was expressed as Risk Ratio with 95 % confidence intervals. Eleven participants were purposively interviewed about their experiences on exiting the trial with interviews analysed using thematic analysis. RESULTS: Forty women were successfully randomised. For women receiving acupuncture there was a statically significant reduction with threatened miscarriage symptoms including bleeding, cramping and back pain compared with the control (p = 0.04). Thematic analysis revealed women were dissatisfied with the medical support and advice received. An overarching theme emerged from the data of 'finding something you can do.' This encompassed the themes: 'they said there was nothing they could do,' 'feeling the benefits' and 'managing while marking time.' CONCLUSION: Acupuncture was a feasible intervention and reduced threatened miscarriage symptoms when compared to a touch intervention. Further research is required to further explore acupuncture use for this common complication and whether it can reduce the incidence of miscarriage. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12610000850077 . Date of registration 12/10/2010. Retrospectively registered, with first participant enrolled 11/10/2012.

A preliminary investigation into psychophysiological effects of threatening a perceptually embodied rubber hand in healthy human participants.

BACKGROUND AND AIMS: Threatening a perceptually embodied rubber hand with noxious stimuli has been shown to generate levels of anxiety similar to that experienced when a real hand is threatened. The aim of this study was to investigate skin conductance response, self-reported anxiety and the incidence, type and location of sensations when a perceptually embodied rubber hand was exposed to threatening and non-threatening stimuli. METHODS: A repeated measures cross-over design was used whereby 20 participants (≥18 years, 14 females) received a threatening (syringe needle) and non-threatening (soft brush) stimulus to a perceptually embodied rubber hand. Perceptual embodiment was achieved using a soft brush to synchronously stroke the participant's real hand (out of view) and a rubber hand (in view). Then the investigator approached the rubber hand with a syringe needle (threat) or soft brush (non-threat). RESULTS: Repeated measures ANOVA found that approaching the perceptually embodied rubber hand with either stimulus produced statistically significant reductions in the rated intensity of response to the following questions (p<0.01): 'How strongly does it feel like the rubber hand is yours?'; 'How strongly does it feel like the rubber hand is part of your body?'; and 'How strongly does it feel you can move the rubber hand?'. However, there were no statistically significant differences in scores between needle and brush stimuli. Repeated measures ANOVA on skin conductance response found statistically significant effects for experimental Events (baseline; stroking; perceptual embodiment; stimuli approaching rubber hand; stimuli touching rubber hand; p<0.001) but not for Condition (needle versus brush p=0.964) or experimental Event×Condition interaction (p=0.160). Ten of the 20 participants (50%) reported that they experienced a sensation arising from the rubber hand when the rubber hand was approached and touched by either the needle and/or brush but these sensations lacked precision in location, timing, and nature. CONCLUSION AND IMPLICATIONS: Our preliminary findings suggest that the increase in arousal in response to stimuli entering the peripersonal space may not be selective for threat. There was tentative evidence that more intense sensations were experienced when a perceptually embodied rubber hand was approached by a threatening stimulus. Our findings provide initial insights and should serve as a catalyst for further research.

"Well I'm safe because " - acupuncturists managing conflicting treatment recommendations when treating threatened miscarriage: a mixed-methods study.

OBJECTIVE: To explore how contraindications to the use of acupuncture during pregnancy are managed in clinical practice. DESIGN: Acupuncturists' views on their management of threatened miscarriage were sought by using a mixed-methods design involving a self-completed questionnaire and semi-structured interviews. An online survey was distributed through the Australian and New Zealand acupuncture associations requesting practitioners' to access an online link to a questionnaire hosted by Survey Monkey. This questionnaire examined acupuncturist's views on safety and the use of Traditional Chinese Medicine treatment modalities. Descriptive and bivariate statistics were used to analyze data. Thirteen participants were purposefully selected from the survey responses to further explore treatment management. These interviews were recorded via Skype, transcribed, and analyzed by using thematic analysis. RESULTS: Of 370 respondents, 214 (58%) had treated women for threatened miscarriage within the previous year. Approximately half (58%) had treated four or fewer women, while a minority (14%) had treated 15 or more. The use of abdominal and blood invigorating points reflected diverse treatment strategies within acupuncture textbooks. While the majority avoided acupuncture points traditionally cautioned against in pregnancy, 13% would use LI 4, 22% would use SP 6, and 31% would use BL 32. Two safety themes emerged: "Well I'm safe because…justifying diverse approaches" and "A limited knowledge base-sorting it out for yourself," illustrating how practitioners justified safe practice and had difficulty obtaining trustworthy treatment knowledge. CONCLUSION: Practitioners demonstrated interest in treating threatened miscarriage. All practitioners saw themselves as providing safe treatment. Those using historically contraindicated points justified their use on the basis of personal opinion, advice from trusted others, and clinical experience with a small number of women. In treating at-risk pregnancies, these justifications may be inadequate. Further research exploring the views of practitioners who are experienced in this specialized area would inform clinical practice for this common complication of early pregnancy.

A search for hope and understanding: an analysis of threatened miscarriage internet forums.

OBJECTIVE: threatened miscarriage is a common complication of early pregnancy, which increases the risk of miscarriage or pregnancy complications such as premature birth. Currently there is limited evidence to recommend beneficial medical treatments or lifestyle changes, resulting in a 'watchful waiting' approach. The aim of this study was to describe women's experiences of threatened miscarriage through examining postings to Internet discussion forums. DESIGN: a Goggle alert for threatened miscarriage was created with emails containing hyperlinks sent to the first author and collected over a seven month period (April to November 2011). Data was analysed using thematic analysis. FINDINGS: one hundred and twenty one discussion threads were collected. The overarching theme that emerged was one of 'a search for hope and understanding'. Within this there were four sub themes that illustrated this search. 'A reason for hope: stories and real life experiences' illustrated how women sought hope for a viable pregnancy through others. 'Becoming the expert,' captures how women gave advice from their own experiences. 'A safe place to share' and 'connecting to empathic support' illustrates how women used this medium for long distance support. KEY CONCLUSION: internet discussion forums were used by women to seek hope and support they were not receiving from their health professionals. Women urged each other to remain hopeful despite a negative medical prognosis. There was an acceptance of a lay expertise within the forums that was valid enough to challenge medical expertise. IMPLICATIONS FOR PRACTICE: health practitioners may need education that helps them balance their delivery of medical information with hope in order to increase feelings of trust. With women seeing the Internet as a useful form of support, it may be relevant for practitioners to consider recommending relevant Internet sites and discuss this with women.

Miscarriage prevention tea affects plasma beta-endorphin concentrations in women with early threatened abortions.

Twenty threatened abortive patients in the 7-8th week of gestation were treated with a classical miscarriage prevention tea (Shou-Tai-Tang) combined with psychological consultation. All of the patients had a history of unexplained recurrent abortions. This treatment succeeded in sixteen out of 20 patients. The plasma concentrations of beta-endorphin (beta-EP), gonadotrophin releasing hormone (GnRH), human chorionic gonadotrophin (hCG), and progesterone (P4) were measured by radioimmunoassay before and after treatment. Compared to control subjects, beta-EP levels were significantly higher, while GnRH, hCG, and P4 were lower than before treatment. Concentrations of these peptides/hormones returned to normal ranges after successful treatment.

[Psychopathologic aspects of abortion and premature labor]. / Psychopathologische Aspekte von Abort und Frühgeburt.

Besides well-known organic reasons also a psychogenic participation in the symptom complex of an imminent abortion respectively an imminent preterm delivery has to be taken into consideration. In this study 15 pregnant women with an imminent abortion respectively an imminent preterm delivery had been investigated by the help of an anamnestic data questionnaire and different psychometric tests. This group had been opposed with a group of 91 women with an uncomplicated course of their pregnancy to disclose expected differences with regard to their personality profile, variables of their partnership and their adjustment, their experienced ancieties and anamnestic data, which shall be of importance for the outcome of the clinical symptoms. The results of this investigation show that among different psychogenic factors it is an asthenic personality profile coupled with neurotical and paranoid assimilation which reduces the psychic capacity of these pregnant women to cope with the adaptation processes of their occurred pregnancy and acuses the outcome of the clinical symptom complex of pretern labour.

[Preliminary report on the neuropsychological study of women treated by beta-mimetic drugs in a gynecological clinic]. / Note préliminaire sur l'étude neuropsychologique de femmes traitées par des bêta-mimétiques en service de gynéco-obstétrique.

Twenty women hospitalized in a gynaecological clinic for threatening miscarriages were treated by beta-mimetic drugs and examined from a neuro-psychological viewpoint. Disorders in the quality of sleep, trembling fingers and modification in the tone of voice were noted, and associated in five cases, to a slight hypertonia, extra-pyramidal-like. Eleven women had difficulties in concentrating, and seventeen felt distressing changes of mood: mentism, pessimistic thoughts, feeling of being abandonned, and sometimes, beliefs of being persecuted, which in two patients required the administration of Haldol.