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Clinical Obstetrics

Poster Session 4

(926) Psychological impact of medical termination of pregnancy: secondary analysis of the multicenter randomized trial DILATOP

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To evaluate the psychological impact of medical termination of pregnancy (TOP) and to determine factors associated with severe psychological impact.

Study Design: Secondary analysis of a multicenter (n= 10 centers) randomized controlled trial comparing the efficacy of cervical dilators inserted concurrently with misoprostol with that of misoprostol alone for women undergoing TOP between 150/7 and 276/7 weeks of gestation. Psychological impact was evaluated by the impact of event scale revised (IES-R) questionnaire self-administered 1 to 4 months after TOP. IES-R is a 22-items scale designed to assess subjective distress caused by traumatic events, validated for use in perinatal medicine. A score ³33 corresponds best to the diagnosis of PTSD and a score ³37 to severe psychological impact. Maternal and obstetrical characteristics associated with a score ≥37 were studied using mixed models. We present results for complete cases and after multiple imputation to account for selective dropouts and missing information at follow-up.

Results: Between November 2017 and September 2019, 347 women were enrolled; 247 IES-R questionnaires were available and 219 fully completed. Median time between TOP and completion of the questionnaire was 7 weeks (IQR 4.9-13.3). The median IES-R score was 31 (IQR 22-42), 46% of women had a score ³ 33 and 37% ³ 37. After multivariable analysis, the only maternal factor associated with an IES-R ³37 was occupation as a blue-collar worker or commercial employee compared to manager. Obstetric or labor-related characteristics as well as parity, gestational age over 22 weeks, use of cervical dilators, labor > 12h, pain or complications during delivery or post-partum were not associated with an IES-R ³37. The results were similar after multiple imputation.

Conclusion: A high proportion of women experiencing medical TOP had a major psychological impact. The absence of vulnerability factors besides occupation, underlines the importance of psychological evaluation after TOP for all women to improve global care.