Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK.
Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
Ultrasound Obstet Gynecol. 2017 Aug;50(2):247-254. doi: 10.1002/uog.17214. Epub 2017 Jun 27.
To determine anxiety levels of women presenting to an early pregnancy assessment unit (EPAU) with abdominal pain and/or vaginal bleeding and to assess how these levels change over time and according to ultrasonographic diagnosis.
We undertook a prospective cohort study in an EPAU in a large UK teaching hospital. Women with abdominal pain and/or vaginal bleeding in early pregnancy (< 12 weeks' gestation) presenting for the first time were eligible for inclusion in the study. State anxiety levels were assessed using the standardized short form of Spielberger's state-trait anxiety inventory (STAI) on three occasions (before, immediately after and 48-72 hours after an ultrasound scan). Scores were correlated with ultrasonographic diagnosis. The diagnosis was either certain or uncertain. Certain diagnoses were either positive, i.e. a viable intrauterine pregnancy (IUP), or negative, i.e. a non-viable IUP or ectopic pregnancy. Uncertain diagnoses included pregnancy of unknown location and pregnancy of uncertain viability. Statistical analysis involved mixed ANOVAs and the post-hoc Tukey-Kramer test.
A total of 160 women were included in the study. Anxiety levels decreased over time for women with a certain diagnosis (n = 128), even when negative (n = 64), and increased over time for women with an uncertain diagnosis (n = 32). Before the ultrasound examination, anxiety levels were high (STAI value, 21.96 ± 1.11) and there was no significant difference between the five groups. Immediately after the ultrasound examination, anxiety levels were lower in the viable IUP group (n = 64; 7.75 ± 1.13) than in any other group. The difference between the five groups was significant (P < 0.005). After 48-72 hours, women with a certain diagnosis had significantly lower anxiety levels than had those with an uncertain diagnosis (10.77 ± 4.30 vs 22.94 ± 1.65; P < 0.005).
The experience of abdominal pain and/or vaginal bleeding in early pregnancy is highly anxiogenic. Following an ultrasound examination, the certainty of the diagnosis affects anxiety levels more than does the positive or negative connotations associated with the diagnosis per se. Healthcare providers should be aware of this when communicating uncertain diagnoses. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
评估因腹痛和/或阴道出血而到早孕评估单位（EPAU）就诊的女性的焦虑水平，并评估这些水平随时间的变化以及根据超声诊断的变化情况。
我们在一家大型英国教学医院的 EPAU 中进行了一项前瞻性队列研究。对于因腹痛和/或阴道出血而在孕早期（<12 周妊娠）首次就诊的女性，若符合纳入标准，则可参与本研究。使用 Spielberger 状态特质焦虑量表（STAI）的标准短式在三个时间点（超声检查前、立即检查后和 48-72 小时后）评估状态焦虑水平。评分与超声诊断相关联。诊断要么是确定的，要么是不确定的。确定的诊断结果为阳性，即宫内活胎妊娠（IUP），或阴性，即宫内非活胎妊娠或异位妊娠。不确定的诊断包括妊娠位置不明和妊娠活力不确定。统计分析涉及混合方差分析和事后 Tukey-Kramer 检验。
共有 160 名女性参与了这项研究。对于诊断明确的女性（n=128），包括阴性（n=64），焦虑水平随时间推移而降低，而对于诊断不确定的女性（n=32），焦虑水平随时间推移而升高。在超声检查前，焦虑水平较高（STAI 值，21.96±1.11），且五个组之间无显著差异。在超声检查后立即，IUP 存活组（n=64）的焦虑水平低于任何其他组（7.75±1.13）。五组之间的差异具有统计学意义（P<0.005）。48-72 小时后，有明确诊断的女性焦虑水平显著低于不确定诊断的女性（10.77±4.30 比 22.94±1.65；P<0.005）。
在孕早期经历腹痛和/或阴道出血会引起高度焦虑。在进行超声检查后，诊断的确定性比诊断本身的阳性或阴性含义对焦虑水平的影响更大。医护人员在交流不确定的诊断时应意识到这一点。
