Is Reassurance Scanning Reassuring?
: Anxiety levels, worries and attitudes of women with a history of recurrent miscarriage and standard risk women to early serial ultrasound scanning in a new pregnancy

Student thesis: Doctoral ThesisDoctor of Medicine by Research

Abstract

Recurrent miscarriage affects 1% of all women and for many the cause will remain unexplained and a significant cause of distress. Evidence suggests that supportive care alone in the setting of an Early Pregnancy Unit increases the likelihood of a subsequent successful outcome to 76%. The mechanism of supportive care is not known and psychological support is poorly defined. Ultrasound examination in the absence of symptoms suggestive of further miscarriage is often the consistent feature of supportive care. Women with recurrent miscarriage have had many scans in previous pregnancies and the result has often been bad news. Is repeated scanning in women who are anxious about the outcome supportive? The work presented here examines the hypothesis that women with a history of recurrent miscarriage have higher background anxiety levels than women who have not had previous pregnancy loss (standard risk) and there is a more significant decrease in anxiety levels in recurrent miscarriage women when measured post scan than standard risk women.

Anxiety levels were assessed at 8 time points using the Stait-Trait Anxiety Inventory (STAI); pre and post ultrasound scan at 6,8 and 10 weeks and at the intervening 7 and 9 weeks at home. Worries were evaluated using the Cambridge Worry Scale (CWS) before the 6 week and after the 10 week scan, coping mechanisms were assessed using the Miller Behavioural Style Scale (MBSS) before the 6 week scan and attitudes towards the scans and pregnancy were evaluated before the 6 week and after the 10 weeks scan using semantic differentiation scales.

Anxiety levels were significantly higher before each scan in the recurrent miscarriage group compared to the standard risk group (p<0.001, p=0.001, p<0.001). Anxiety levels significantly decreased by a greater amount in the recurrent miscarriage group (p=0.012, p=0.025, p=0.001), this was short lived as anxiety increased again by 7 and 9 weeks independent of scanning. After the 10-week scan anxiety levels in both groups were not significantly different. Using mixed model analysis the number of children significantly reduced anxiety levels pre scan. The main worry before the 10-week scan was of miscarriage in both groups, this worry did significantly reduce by 10 weeks, but was still the leading cause of worry in the recurrent miscarriage group. All participants were significantly more positive towards the pregnancy and scans after the 10-week scan.

This data demonstrates that anxiety levels are higher in women with recurrent miscarriage when compared to women with no previous adverse pregnancy outcomes. It provides evidence that in women with recurrent miscarriage and standard risk, scanning lowers anxiety levels immediately following the scan and that women have increased positivity as a result of scanning.
Date of Award1 Oct 2021
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJane Sandall (Supervisor) & Jude Hamilton (Supervisor)

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