Ho Angela L, Hernandez Algeny, Robb John M, Zeszutek Stephanie, Luong Sandy, Okada Emiru, Kumar Karan
Obstetrics and Gynecology, Touro College of Osteopathic Medicine, Middletown, USA.
Obstetrics and Gynecology, University of California Irvine, Irvine, USA.
Cureus. 2022 Apr 19;14(4):e24269. doi: 10.7759/cureus.24269. eCollection 2022 Apr.
The estimated frequency of spontaneous miscarriage is about a quarter of all clinically identified pregnancies in the United States. Women typically go to the emergency department (ED) or outpatient clinic when they experience symptoms, including but not limited to vaginal bleeding, abdominal pain, and contractions. The care that is provided varies from place to place.
Researchers searched articles from 2010 to 2021 for reports mentioning treatment for spontaneous abortion. Search terms included "miscarriage aftercare" and "spontaneous abortion care," seeking articles addressing the psychological effects of miscarriage and reporting patient experiences in different clinical settings. Data were independently reviewed, graded for evidence quality, and assessed for risk bias using the AMSTAR checklist.
The search strategy yielded 2,275 articles, six of which met the inclusion criteria. Conservative, medical, and surgical management were provided, with surgical management being more common among women with higher education and socioeconomic status. All qualitative studies reported dissatisfaction with care provided in the emergency department, partially due to a lack of emotional support. Structured bereavement intervention was beneficial for women experiencing early pregnancy loss and led to fewer reports of despair. The quantitative studies referenced interventions that aided patients in coping with pregnancy loss and identified several factors influencing the type of treatment received as well as the patient's ability to cope with feeling depressed following a miscarriage.
Psychological management is not regularly addressed in the emergency department, and protocols including bereavement education for healthcare providers as well as patient involvement in management would improve the overall patient experience with spontaneous miscarriage care.
在美国，估计自然流产的发生率约占所有临床确诊妊娠的四分之一。女性出现症状（包括但不限于阴道出血、腹痛和宫缩）时通常会前往急诊科（ED）或门诊就诊。各地提供的护理不尽相同。
研究人员检索了2010年至2021年提及自然流产治疗的文章。检索词包括“流产后护理”和“自然流产护理”，寻找涉及流产心理影响以及不同临床环境下患者经历的文章。数据由独立人员进行审查，根据证据质量分级，并使用AMSTAR清单评估风险偏倚。
检索策略共获得2275篇文章，其中6篇符合纳入标准。提供了保守治疗、药物治疗和手术治疗，手术治疗在受过高等教育和社会经济地位较高的女性中更为常见。所有定性研究均报告了对急诊科提供的护理不满，部分原因是缺乏情感支持。结构化的哀伤干预对早期妊娠丢失的女性有益，且绝望报告较少。定量研究引用了帮助患者应对妊娠丢失的干预措施，并确定了影响治疗类型以及患者流产后应对抑郁情绪能力的几个因素。
急诊科通常不进行心理管理，包括对医护人员进行哀伤教育以及让患者参与管理的方案将改善患者自然流产护理的总体体验。
