Investigation of the preferred abortion method among women with consecutive spontaneous abortions
Authors
Ramsgaard-Jensen, Anna ; Heinrichsen, Christina Nørnberg
Term
5. Term (Master thesis)
Education
Publication year
2023
Submitted on
2023-01-05
Pages
16
Abstract
Baggrund og formål: Gentagne graviditetstab rammer 1–2 % af kvinder. Nogle forløb er en “missed abortion” (forbi-gået abort), hvor graviditeten er gået til grunde, men vævet ikke kommer ud af sig selv, og der derfor er behov for behandling. Danske retningslinjer anbefaler som udgangspunkt medicinsk frem for kirurgisk behandling, men få studier har undersøgt, hvad kvinder med gentagne graviditetstab foretrækker. Denne undersøgelse skulle finde mulige forudsigere for, om kvinder foretrækker medicinsk eller kirurgisk behandling, og afklare hvordan bivirkninger påvirker deres oplevelser. Metode: Kvinder henvist til Center for Gentagne Graviditetstab i Vestdanmark, som mellem januar 2016 og september 2022 havde fået både medicinsk og kirurgisk behandling for missed abortion, modtog et spørgeskema om deres erfaringer (n = 157); 87 svarede og indgik i analysen. Svarene blev sammenlignet, og der blev undersøgt sammenhænge mellem oplevelser og behandlingspræferencer. Resultater: Signifikant flere kvinder rapporterede højere smerteintensitet og større forbrug af smertestillende efter deres første medicinske behandling end efter deres første kirurgiske. Hos kvinder, der første gang blev behandlet medicinsk, havde blødning, smerter, længere sygemelding og psykisk ubehag større betydning for deres valg af behandling ved næste missed abortion. Der blev rapporteret en fejlraten for medicinsk behandling på 44,8 %. Kvinder, der tidligere havde født, var cirka tre gange så tilbøjelige til at foretrække medicinsk behandling. Kvinder, der havde fået medicinsk behandling ved deres første missed abortion, var mindre tilbøjelige (omkring en tredjedel så tilbøjelige) til at foretrække medicinsk behandling senere. Samlet ville 66,7 % foretrække kirurgisk behandling ved en kommende missed abortion, og 33,3 % ville foretrække medicinsk. Konklusion: Tidligere fødsel er en positiv forudsiger for at foretrække medicinsk behandling, men i denne gruppe foretrak flest kirurgisk behandling. At have fået medicinsk behandling første gang var forbundet med at fravælge den senere, og medicinsk behandling hang sammen med flere bivirkninger og en høj fejlraten i denne kohorte. Fundene kan forklare den udbredte præference for kirurgi og peger på, at de nuværende anbefalinger kan kræve revurdering for kvinder med gentagne graviditetstab, der står over for missed abortion.
Background and aim: Recurrent pregnancy loss affects 1–2% of women. Some episodes are a “missed abortion,” where the pregnancy has ended but the tissue has not passed on its own, so treatment is needed. Danish guidelines currently favor medical over surgical management, but few studies have examined what women with recurrent pregnancy loss prefer. This study sought to identify predictors of women’s preference for medical versus surgical treatment and to clarify how side effects shape their experiences. Methods: Women referred to the Centre for Recurrent Pregnancy Loss of Western Denmark who, between January 2016 and September 2022, had undergone both medical and surgical treatment for missed abortion received a questionnaire about their experiences (n = 157); 87 responded and were included. Responses were compared, and analyses explored associations between experiences and treatment preferences. Results: Significantly more women reported higher pain intensity and greater use of painkillers after their first medical management than after their first surgical management. Among women whose first missed abortion was treated medically, bleeding, pain, longer sick leave, and mental discomfort had a stronger influence on their subsequent treatment choice. A reported failure rate of 44.8% for medical treatment was observed. Women who had previously given birth were about three times more likely to prefer medical treatment. Women whose first missed abortion was treated medically were less likely (about one-third as likely) to prefer medical treatment later. Overall, 66.7% would choose surgical management for a future missed abortion, and 33.3% would choose medical management. Conclusion: Prior childbirth predicts a preference for medical management, yet most women in this group preferred surgical management. Experiencing medical treatment first was linked to not choosing it again, and medical management was associated with more side effects and a high failure rate in this cohort. These findings may explain the stronger preference for surgery and suggest current recommendations should be reconsidered for women with recurrent pregnancy loss facing missed abortion.
[This summary has been rewritten with the help of AI based on the project's original abstract]
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