Iles S
Baillieres Clin Obstet Gynaecol. 1989 Dec;3(4):769-90. doi: 10.1016/s0950-3552(89)80064-1.
It is often assumed that early loss of pregnancy is not followed by emotional distress. When such distress does occur, it often goes undetected. Early loss of pregnancy is frequently followed by typical grief such as that occurring after any bereavement. Most recent studies have shown that although social termination of pregnancy in the first trimester has few adverse psychological sequelae for most women, there are vulnerable women who do experience significant emotional distress afterwards. Risk factors for poor psychological outcome include poor social support, past psychiatric history and ambivalence about the termination. The procedures used for second trimester terminations of pregnancy are likely to be a particular source of distress. Psychiatric disorder may also follow if termination is refused. Careful assessment of all women before social termination will identify vulnerable women who may benefit from counselling and support afterwards. After spontaneous abortion or miscarriage, many women experience significant emotional distress, which persists for several months. Guilt and anger are common. Some women are particularly vulnerable to developing psychiatric disorder after spontaneous abortion, for example women with a past psychiatric history, poor social support, previous spontaneous abortion and personality traits such as neuroticism. Many women would benefit from follow-up and support afterwards; extra support and reassurance are often needed during the next pregnancy. Termination for fetal abnormality is more likely to induce grief than relief for many women; these pregnancies are usually wanted, second trimester terminations are distressing, and there is often guilt at destroying a life and/or opting out of rearing a handicapped child. Recent research has demonstrated substantial levels of psychiatric morbidity after termination for fetal abnormality, particularly in those with a past psychiatric history, those with poor social support, and those who feel they have opted out of bearing a handicapped child. Women receive little support of follow-up after such terminations, yet many would benefit from it. Such women are in particular need of reassurance and support during a subsequent pregnancy.
人们常常认为，早期妊娠丢失后不会出现情绪困扰。当这种困扰确实出现时，往往未被察觉。早期妊娠丢失后常常会出现典型的悲痛情绪，就像经历任何丧亲之痛后一样。最近的研究表明，虽然大多数女性在孕早期进行人工流产后几乎没有不良心理后遗症，但仍有一些易受影响的女性在此之后确实会经历严重的情绪困扰。心理结局不佳的风险因素包括社会支持不足、既往精神病史以及对人工流产的矛盾心理。孕中期人工流产所采用的程序可能是困扰的一个特别来源。如果人工流产被拒绝，也可能会引发精神障碍。在进行人工流产前对所有女性进行仔细评估，将识别出那些可能在之后受益于咨询和支持的易受影响的女性。自然流产或稽留流产后，许多女性会经历严重的情绪困扰，这种困扰会持续数月。内疚和愤怒很常见。一些女性在自然流产后特别容易患上精神障碍，例如有既往精神病史、社会支持不足、既往有自然流产史以及具有神经质等人格特质的女性。许多女性在此之后会受益于随访和支持；在下一次怀孕期间通常需要额外的支持和安慰。对许多女性来说，因胎儿异常而终止妊娠更可能引发悲痛而非解脱；这些妊娠通常是她们想要的，孕中期终止妊娠令人痛苦，而且在毁掉一个生命和/或选择不抚养一个残疾孩子时往往会有内疚感。最近的研究表明，因胎儿异常而终止妊娠后存在大量精神疾病，尤其是在有既往精神病史、社会支持不足以及认为自己选择不生育残疾孩子的女性中。这些女性在终止妊娠后很少得到随访支持，但许多人会从中受益。在随后的怀孕过程中，这类女性尤其需要安慰和支持。
