Posttraumatic stress disorder after second trimester medical termination of pregnancy.
To evaluate the risk of posttraumatic stress disorder (PTSD) after indicated second-trimester termination of pregnancy (TOP) and to identify factors associated with a probable diagnosis of severe PTSD.
Secondary analysis of a multicenter randomized controlled trial comparing the efficacy of cervical dilators inserted concurrently with misoprostol with that of misoprostol alone for women undergoing TOP between 150/7 and 276/7 weeks of gestation. PTSD was evaluated by the Impact of Event Scale-Revised (IES-R) questionnaire, self-administered 1-4 months after TOP. This 22-item scale is designed to assess subjective distress caused by traumatic events and has been validated in perinatal care. The literature suggests that a score ≥33 indicates a probable diagnosis of PTSD and a score ≥37 a probable diagnosis of severe PTSD. Maternal and obstetric characteristics associated with a score ≥37 were studied with mixed models. We present results after multiple imputation to take selective dropouts and missing information at follow-up into account and for complete cases.
Among the 347 women enrolled, 247 (71.2%) IES-R questionnaires were available. Median time between TOP and completion of the questionnaire was 7 weeks (IQR, 4.9-13.3). The mean IES-R score was 32.1 (SD 15.4) The IES-R score was ≥33 for 44.9% (95%CI, 38.4-51.4) of women and ≥37 for 35.8% (95%CI, 29.7-41.8). After multivariate analysis, obstetric or labor-related characteristics such as parity, gestational age over 22 weeks, use of cervical dilators, labor > 12 h, and pain or complications during delivery or postpartum were not associated with an IES-R ≥37. The results were similar in complete cases.
Nearly half of women undergoing medically indicated second-trimester TOP were at risk of PTSD and more than one-third of severe PTSD. The absence of risk factors underlines the potential benefits of systematic psychological evaluation after TOP for all women.
Secondary analysis of a multicenter randomized controlled trial comparing the efficacy of cervical dilators inserted concurrently with misoprostol with that of misoprostol alone for women undergoing TOP between 150/7 and 276/7 weeks of gestation. PTSD was evaluated by the Impact of Event Scale-Revised (IES-R) questionnaire, self-administered 1-4 months after TOP. This 22-item scale is designed to assess subjective distress caused by traumatic events and has been validated in perinatal care. The literature suggests that a score ≥33 indicates a probable diagnosis of PTSD and a score ≥37 a probable diagnosis of severe PTSD. Maternal and obstetric characteristics associated with a score ≥37 were studied with mixed models. We present results after multiple imputation to take selective dropouts and missing information at follow-up into account and for complete cases.
Among the 347 women enrolled, 247 (71.2%) IES-R questionnaires were available. Median time between TOP and completion of the questionnaire was 7 weeks (IQR, 4.9-13.3). The mean IES-R score was 32.1 (SD 15.4) The IES-R score was ≥33 for 44.9% (95%CI, 38.4-51.4) of women and ≥37 for 35.8% (95%CI, 29.7-41.8). After multivariate analysis, obstetric or labor-related characteristics such as parity, gestational age over 22 weeks, use of cervical dilators, labor > 12 h, and pain or complications during delivery or postpartum were not associated with an IES-R ≥37. The results were similar in complete cases.
Nearly half of women undergoing medically indicated second-trimester TOP were at risk of PTSD and more than one-third of severe PTSD. The absence of risk factors underlines the potential benefits of systematic psychological evaluation after TOP for all women.
Authors
Anselem Anselem, Vivanti Vivanti, Bouchghoul Bouchghoul, Quibel Quibel, Winer Winer, Jouannic Jouannic, Castaigne Castaigne, Perdriolle-Galet Perdriolle-Galet, Massardier Massardier, Rousseau Rousseau, Rahmethnissah Rahmethnissah, Tsatsaris Tsatsaris, Ancel Ancel, Goffinet Goffinet,
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