- Email: [email protected]
Does abortion technique influence the course of perinatal grief in second trimester termination for fetal anomalies?
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Letters to the Editors percentages of infections among the mothers regardless of when antibiotics were administered. John Morrison Department of Obstetrics and Gynecology University of Mississippi Medical Center Jackson, MI 39216 E-mail: [email protected]
References 1. Thigpen BD, Hood WA, Chauhan S, Bufkin L, Bofill J, Magann E, et al. Timing of prophylactic antibiotic administration in the uninfected laboring gravida: a randomized clinical trial. Am J Obstet Gynecol 2005;192:1864-71. 2. Classen D, Evans R, Pestotnik S, Horn S, Menlove R, Burke J. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281-6.
0002-9378/$ - see front matter Ó 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2005.10.216
Does abortion technique influence the course of perinatal grief in second trimester termination for fetal anomalies? To the Editors: We read with great interest the important paper of Burgoine et al1 regarding a comparison of perinatal grief after dilation and evacuation (D&E) or induction of labor (IOL) in second trimester terminations for fetal anomalies. The issue is of great interest because women who terminate their pregnancies for fetal anomalies experience intensive grief reactions which, in some cases, even can lead to psychiatric diseases.2 The aim of the study was to investigate the hypothesis that choice of abortion technique of second trimester termination of pregnancy influences perinatal grieving. However, it should be noted that the presented study design does not allow examining the hypothesis intended by the authors. Proving the hypothesis that choice of abortion technique influences perinatal grief would have required a randomized assignment of patients to 1 of 3 groups (D&E group, IOL-group, or self-selection group). In this study, only a self-selected group was examined, in which patients could choose between 2 procedures. Hence, this study solely showed that the women in the investigation do not differ concerning the extent of depression and perinatal grief, if they had chosen the abortion technique themselves. Furthermore, the authors did not assess traumatic experience after termination of a desired pregnancy, which might complicate the process of accepting the loss of the child. In a retrospective study of 83 women after termination of pregnancy caused by fetal anomalies we found that posttraumatic responses as well as intense grief reactions are still detectable 2 to 7 years after the loss.3 In our study, the abortion was performed by induction of labor. Some women experienced this process of giving birth as 0002-9378/$ - see front matter Ó 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2005.10.220
especially traumatizing. Thus, it would be interesting to examine whether the varying abortion techniques have a diferential traumatic impact on the women. Despite the interesting results of Burgoine et al, further studies are required to examine the influence of the abortion technique on the process of handling and accepting the loss after termination of a desired pregnancy more differentiated, especially concerning the extent of perinatal grief and traumatic experience. Anette Kersting* Kristin Kroker Department of Psychiatry University of Muenster Muenster, Germany *E-mail: [email protected] Johannes Steinhard Department of Gynecology and Obstetrics University of Muenster Muenster, Germany
References 1. Burgoine GA, Van Kirk SD, Romm J, Edelman AB, Jacobson SL, Jensen J. Comparison of perinatal grief after dilation and evacuation or labor induction in second trimester terminations for fetal anomalies. Am J Obstet Gynecol 2005;192:1928-32. 2. Iles S, Gath D. Psychiatric outcome of TOP for foetal abnormality. Psychol Med 1993;23:407-13. 3. Kersting A, Dorsch M, Kreulich C, Reutemann M, Ohrmann P, Baez E, et al. Trauma and grief 2-7 years after termination of pregnancy because of fetal anomaliesda pilot study. J Psychosom Obstet Gynecol 2005;26:9-14.
Letters to the Editors percentages of infections among the mothers regardless of when antibiotics were administered. John Morrison Department of Obstetrics and Gynecology University of Mississippi Medical Center Jackson, MI 39216 E-mail: [email protected]
References 1. Thigpen BD, Hood WA, Chauhan S, Bufkin L, Bofill J, Magann E, et al. Timing of prophylactic antibiotic administration in the uninfected laboring gravida: a randomized clinical trial. Am J Obstet Gynecol 2005;192:1864-71. 2. Classen D, Evans R, Pestotnik S, Horn S, Menlove R, Burke J. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281-6.
0002-9378/$ - see front matter Ó 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2005.10.216
Does abortion technique influence the course of perinatal grief in second trimester termination for fetal anomalies? To the Editors: We read with great interest the important paper of Burgoine et al1 regarding a comparison of perinatal grief after dilation and evacuation (D&E) or induction of labor (IOL) in second trimester terminations for fetal anomalies. The issue is of great interest because women who terminate their pregnancies for fetal anomalies experience intensive grief reactions which, in some cases, even can lead to psychiatric diseases.2 The aim of the study was to investigate the hypothesis that choice of abortion technique of second trimester termination of pregnancy influences perinatal grieving. However, it should be noted that the presented study design does not allow examining the hypothesis intended by the authors. Proving the hypothesis that choice of abortion technique influences perinatal grief would have required a randomized assignment of patients to 1 of 3 groups (D&E group, IOL-group, or self-selection group). In this study, only a self-selected group was examined, in which patients could choose between 2 procedures. Hence, this study solely showed that the women in the investigation do not differ concerning the extent of depression and perinatal grief, if they had chosen the abortion technique themselves. Furthermore, the authors did not assess traumatic experience after termination of a desired pregnancy, which might complicate the process of accepting the loss of the child. In a retrospective study of 83 women after termination of pregnancy caused by fetal anomalies we found that posttraumatic responses as well as intense grief reactions are still detectable 2 to 7 years after the loss.3 In our study, the abortion was performed by induction of labor. Some women experienced this process of giving birth as 0002-9378/$ - see front matter Ó 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2005.10.220
especially traumatizing. Thus, it would be interesting to examine whether the varying abortion techniques have a diferential traumatic impact on the women. Despite the interesting results of Burgoine et al, further studies are required to examine the influence of the abortion technique on the process of handling and accepting the loss after termination of a desired pregnancy more differentiated, especially concerning the extent of perinatal grief and traumatic experience. Anette Kersting* Kristin Kroker Department of Psychiatry University of Muenster Muenster, Germany *E-mail: [email protected] Johannes Steinhard Department of Gynecology and Obstetrics University of Muenster Muenster, Germany
References 1. Burgoine GA, Van Kirk SD, Romm J, Edelman AB, Jacobson SL, Jensen J. Comparison of perinatal grief after dilation and evacuation or labor induction in second trimester terminations for fetal anomalies. Am J Obstet Gynecol 2005;192:1928-32. 2. Iles S, Gath D. Psychiatric outcome of TOP for foetal abnormality. Psychol Med 1993;23:407-13. 3. Kersting A, Dorsch M, Kreulich C, Reutemann M, Ohrmann P, Baez E, et al. Trauma and grief 2-7 years after termination of pregnancy because of fetal anomaliesda pilot study. J Psychosom Obstet Gynecol 2005;26:9-14.