15 June 2012
UK: Follow-up for improving psychological well being for women after a miscarriage
The authors concluded that evidence is insufficient to demonstrate that psychological support such as counselling is effective post-miscarriage. From Cochrane Database of Systematic Reviews.
The authors note that miscarriage is the premature expulsion of an embryo or fetus from the uterus up to 23 weeks of pregnancy and weighing up to 500 grams. International studies using diagnostic tools have identified that some women suffer from anxiety, depression and grief after miscarriage. Psychological follow-up might detect those women who are at risk of psychological complications following miscarriage. This review is necessary as the evidence is equivocal on the benefits of psychological follow-up after miscarriage.
The study’s objectives were to ascertain whether follow-up affects the psychological well being of women following miscarriage.
The authors searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (31 December 2011), reference lists of all retrieved papers and contacted professional and lay organisations to obtain any ongoing trials or unpublished data. Randomised controlled trials only were included. All potential trials for eligibility according to the criteria specified in the protocol by screening the titles and abstracts, retrieving full reports of potentially relevant trials for assessment. All review authors extracted data and checked for accuracy. No studies were published in duplicate. When data were missing and only the abstract was available, the authors attempted to contact the trial authors. They resolved any disagreement through discussion.
Six studies involving 1001 women were included. Three trials compared one counselling session with no counselling. There was no significant difference in psychological well being including anxiety, grief, depression avoidance and self-blame. One trial compared three one-hour counselling sessions with no counselling at four and 12 months. Some subscales showed statistical significance in favour of counselling and some in favour of no counselling. The results for two trials were given in narrative form as data were unavailable for meta-analyses. One trial compared multiple interventions. The other trial compared two counselling sessions with no counselling. Neither study favoured counselling.
The authors concluded that evidence is insufficient to demonstrate that psychological support such as counselling is effective post-miscarriage. Further trials should be good quality, adequately-powered using standardised interventions and outcome measures at specific time points. The economic implications and women’s satisfaction with psychological follow-up should also be explored in any future study.
Follow-up for improving psychological well being for women after a miscarriage. Murphy FA, Lipp A, Powles DL. Cochrane Database of Systematic Reviews. 2012 Mar 14;3:CD008679.