Abstract
Supportive care is regularly offered to women with recurrent miscarriages (RMs). Their preferences for supportive care in their next pregnancy have been identified by qualitative research. The aim of this study was to quantify these supportive care preferences and identify women's characteristics that are associated with a higher or lower need for supportive care in women with RM. A questionnaire study was conducted in women with RMs (≥ 2 miscarriages) in three hospitals in the Netherlands. All women who received diagnostic work-up for RMs from January 2010 to December 2010 were sent a questionnaire. The questionnaire quantified supportive care options identified by a previous qualitative study. We next analysed associations between women's characteristics (age, ethnicity, education level, parity, pregnancy during questionnaire and time passed since last miscarriage) and their feelings about supportive care options to elucidate any differences between groups. Two hundred and sixty-six women were asked to participate in the study. In total, 174 women responded (response rate 65%) and 171 questionnaires were analysed. Women with RM preferred the following supportive care options for their next pregnancy: a plan with one doctor who shows understanding, takes them seriously, has knowledge of their obstetric history, listens to them, gives information about RM, shows empathy, informs on progress and enquires about emotional needs. Also, an ultrasound examination during symptoms, directly after a positive pregnancy test and every 2 weeks. Finally, if a miscarriage occurred, most women would prefer to talk to a medical or psychological professional afterwards. The majority of women expressed a low preference for admission to a hospital ward at the same gestational age as previous miscarriages and for bereavement therapy. The median preference, on a scale from 1 to 10, for supportive care was 8.0. Ethnicity, parity and pregnancy at the time of the survey were associated with different preferences, but female age, education level and time passed since the last miscarriage were not. Women with RM preferred a plan for the first trimester that involved one doctor, ultrasounds and the exercise of soft skills, like showing understanding, listening skills, awareness of obstetrical history and respect towards the patient and their miscarriage, by the health care professionals. In the event of a miscarriage, women prefer aftercare. Women from ethnic minorities and women who were not pregnant during the questionnaire investigation were the two patient groups who preferred the most supportive care options. Tailor-made supportive care can now be offered to women with RM.
Highlights
Recurrent miscarriage (RM) is defined as two or more miscarriages before 20 weeks of pregnancy and affects 1–5% of all couples (Rai and Regan, 2006)
Women that were not pregnant during the survey were more likely to prefer bHCG sampling prior to the first ultrasound, counselling from a social worker, ultrasound assessment directly following a positive pregnancy test, medication, the doctors’ knowledge of the home situation and ultrasound once every week for the first 12 weeks of pregnancy than women who were pregnant. This questionnaire study investigated which supportive care options for their pregnancy women with RM most commonly preferred and identified characteristics associated with the need for supportive care
The majority of the women did not express a wish to be admitted to a hospital ward at the same gestational age as previous miscarriages nor to receive bereavement therapy
Summary
Recurrent miscarriage (RM) is defined as two or more miscarriages before 20 weeks of pregnancy and affects 1–5% of all couples (Rai and Regan, 2006). Current guidelines from the European Society of Human Reproduction and Embryology (ESHRE) and the Royal College of Obstetricians and Gynaecologists (RCOG) recommend supportive care during the pregnancy for women with unexplained RM (Jauniaux et al, 2006; RCOG, 2011), suggesting that it has a beneficial effect. Women identified 20 different supportive care options; 16 of these options were preferred for their pregnancy. Among the preferred supportive care options were early and frequently repeated ultrasounds, bHCG monitoring, practical advice concerning life style and diet, emotional support in the form of counselling, a clear policy for the upcoming 12 weeks and medication. We investigated which supportive care options are most commonly preferred by women with RM in their pregnancy and identified women’s characteristics that are associated with a higher or lower need for supportive care in women with RM
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