Nikcević Ana V, Kuczmierczyk Andrzej R, Nicolaides Kypros H
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical, School, London, United Kingdom.
J Psychosom Res. 2007 Sep;63(3):283-90. doi: 10.1016/j.jpsychores.2007.04.004. Epub 2007 Aug 2.
The aim of this study was to examine the impact of medical and psychological interventions on women's distress after early miscarriage.
This was a prospective study of women attending for a routine scan at 10-14 weeks of gestation and found to have a missed miscarriage. An intervention group of 66 women had medical investigations to ascertain the cause of miscarriage, and at 5 weeks after the scan, they all had a medical consultation to discuss the results of the investigations. These 66 women were randomly allocated into a group which received further psychological counselling (MPC, n=33), and a group which received no psychological counselling (MC, n=33). They were compared to a control group of 61 women who received no specific postmiscarriage counselling. All participants completed preintervention and postintervention measures and 4-month follow-up questionnaires.
The scores on the outcome variables decreased significantly with time for all three groups. In group MPC, compared to controls, there was a significantly greater decrease over time in the levels of grief, self-blame, and worry and, compared to MC group, a significantly greater decrease in grief and worry. In group MC, compared to controls, there was a significantly greater decrease in self-blame. In the MC and MPC groups, those with an identified cause of the miscarriage had significantly lower levels of anxiety and self-blame over time than those with a nonidentified cause.
Psychological counselling, in addition to medical investigations and consultation, is beneficial in reducing women's distress after miscarriage. However, absence of an identifiable cause of miscarriage led to the maintenance of the initial anxiety levels, which should have otherwise decreased with time.
本研究旨在探讨医学和心理干预对早期流产后女性痛苦的影响。
这是一项对妊娠10 - 14周进行常规扫描且被诊断为稽留流产的女性的前瞻性研究。66名女性组成的干预组接受医学检查以确定流产原因，在扫描后5周，她们均接受医学咨询以讨论检查结果。这66名女性被随机分为两组，一组接受进一步心理咨询（MPC组，n = 33），另一组不接受心理咨询（MC组，n = 33）。将她们与61名未接受流产后特定咨询的女性组成的对照组进行比较。所有参与者均完成干预前和干预后的测量以及4个月的随访问卷。
三组的结局变量得分均随时间显著下降。在MPC组中，与对照组相比，悲伤、自责和担忧水平随时间的下降幅度显著更大，与MC组相比，悲伤和担忧的下降幅度显著更大。在MC组中，与对照组相比，自责的下降幅度显著更大。在MC组和MPC组中，查明流产原因的女性随着时间推移焦虑和自责水平明显低于未查明原因的女性。
除医学检查和咨询外，心理咨询有助于减轻流产后女性的痛苦。然而，流产原因不明导致初始焦虑水平持续存在，否则焦虑水平应会随时间下降。
