In modern obstetrics, considerable attention is paid to the problem of perinatal losses, both in psychological and medical circles. Despite the progressive development of perinatal psychology, the availability of psychologists in the staff of the maternity hospital, the issue of care for women with antenatal fetal death (AED) need further interdisciplinary development. According to state statistics, the main share in the structure of perinatal mortality is antenatal fetal death - 78%, which has a negative impact on both women and medical staff. At the same time, physicians have general feelings that can negatively affect their psychological state. The so-called emotional burnout syndrome appears.
Peculiarities of a woman's psychological state during pregnancy, the dynamics of its changes are prognostic to identify the type of mother-child relationship after childbirth, so even during pregnancy we can confidently conclude that it is possible to provide adequate education for future generations.
Loss of pregnancy is accompanied by a sharp change in the psyche of women, which is manifested by depression, emotional stress, fear of subsequent attempts to have a child. It is also exacerbated by the fact that abortion is accompanied by pain, bleeding or hemorrhage, surgery, and sometimes extended surgery. The combination of stress with burdened sociocultural and psychological factors as a result forms a complex picture of traumatic experience, the so-called "interacting trauma" according to Emerson.
The incidence of depression during pregnancy in the world ranges from 15% to 65%. According to the world literature, the reasons for the high prevalence of depression are insufficient social and partner support during pregnancy, difficult living conditions, personal hidden fears and mental disorders. Given that pregnancy itself is a psychological burden on a woman's nervous system, and pregnant women with a history of RAM have "interacting trauma", the issue of psychological support of pregnant women is highly relevant.
The aim of our study is to assess the psycho-emotional state of women with a history of intrauterine fetal death to improve the tactics of pregnancy follow-up in this group of patients.
Materials and methods
We conducted a 2-stage survey of 59 pregnant women: a retrospective analysis of 34 birth histories of cases of intrauterine fetal death (IFD). The task of the retrospective survey was to find out the main causes of IFD. At the second stage: a prospective study of the psycho-emotional state of these pregnant women (34 pregnant women with a history of IFD, whose histories were studied in retrospect) by questionnaire on the basis of Municipal Nonprofit Enterprise "Kyiv City Maternity Hospital №3" for the period 2015 - 2020. The control group included pregnant women who were giving birth for the first time with an uncomplicated pregnancy, no burdened general and obstetric and gynecological history (n = 25). We used a test for the study to determine the personal and situational anxiety of Spielberger-Khanin and a test of the attitude of the pregnant woman according to I.V.Dobryakov
Results and discussion
In retrospect, it was found that the causes of intrauterine fetal death during previous pregnancies were: preeclampsia in the second half of pregnancy and, as a consequence, premature detachment of the normally located placenta - 18 cases (52.9%); umbilical cord anomalies (umbilical cord entanglement around the neck and/or fetal torso, true umbilical cord node) - 9 cases (26.5%); extragenital pathology, anomalies of fetal development - 3 cases (8.8%) and intrauterine death of unknown origin - 4 cases (11.7%).
The following results were obtained when assessing the psycho-emotional state with the help of the Spielberger-Khanin questionnaires: the average score for determining personal anxiety in the main group was 51, which indicates a high level of anxiety for pregnancy and personal health. The control group had a significantly lower average score - 26 points. The results obtained are presented in Table 1.
|The level of personal anxiety||The value of the indicator in the survey groups (n)|
|Main group (n=34)||Control group (n=25)|
|abs. amount||%||abs. amount||%|
|Low (<30 points)||5||14.7*||13||52|
|Moderate (31–44 points)||9||26.5||8||32|
|High (> 45 points)||20||58.8*||4||16|
A low level of personal anxiety was found in the main group in 14.7% of pregnant women, which is significantly less than in 52% of pregnant women in the control group. A high level of personal anxiety is characteristic of the vast majority of pregnant women in the main group (found in 58.8% of women), while in pregnant women of the control group, a high rate of personal anxiety was found in only 16% of respondents. Such indicators can be explained by the internal anxiety of a pregnant woman who had a history of intrauterine fetal death, guilt feeling in the loss of a previous pregnancy, concentrate on a negative experience, feelings about the condition of the fetus during the current pregnancy.
The levels of situational anxiety of the examined pregnant women were also established: the average value of situational anxiety indicators in the main group was: the main group - 47 points, the control group - 32 points.
Every second woman (44.1% of tested pregnant women) of the main group showed a high level of situational anxiety, which indicates fear of future births, fear of their own incompetence in caring for the child, the aspects of insecurity in the ability to bear a future child are specified. In the control group, there was found a high level of situational anxiety in one in five pregnant women only (20% of women). This is due to the individual family and social influences of each individual pregnant woman (Table 2)
|Level of situational anxiety||The value of the indicator in the survey groups (n)|
|Main group (n=34)||Control group (n=25)|
|abs. amount||%||abs. amount||%|
|Low (<30 points)||7||20.6*||14||56|
|Moderate (31–44 points)||12||35.3*||6||24|
|High (> 45 points)||15||44.1*||5||20|
Analysis of the survey results of pregnant women on the psychological type of childbirth dominant allows to divide women as follows:
- Optimal type: women are in a state of psychological comfort. When evaluating the test results, 60% (15 pregnant women) of the control group belonged to this type, in the main group of pregnant women there were no women with the optimal type of gestational dominance detected.
- Depressive type of gestational dominance was found in 76.5% (26 women) of the main group and only 4% (1 case) of pregnant women in the control group. Women of this type have the most pronounced anxiety about the future child, there are hypochondriac ideas, intentions to give birth soon.
- The euphoric type is expressed by lightheartedness, high spirits, carefreeness and confidence in a successful birth. Pregnant women with this type believe that the history of prenatal loss occurred by accident. They begin to neglect examinations, do not follow the recommendations of doctors in compliance with the rest regime. In the main group - 2 cases (5.9%), and in the control - 4 cases (16%).
- The hypogestognostic type is characterized by underestimation of the importance and seriousness of this condition. Women who have this type of ancestral dominance are not inclined to change their life stereotypes. As a rule, these women have hypogalactia in the postpartum period. From the control group, this type of attitude was demonstrated by 3 women (12%), and from the main group - 2 (5.9%) pregnant women.
- Anxiety type is observed in women with a high level of anxiety, which directly affects the somatic condition of the pregnant woman. In some cases, the pregnant woman cannot even explain the cause of the internal anxiety. In such patients, this is manifested by excessive examinations and consultations with various specialists during pregnancy. In the main group, 4 pregnant women (11.8%) had an anxious type of behavior, and in the control group - 2 (8%) women.
Thus, according to the results of our research, pregnant women with IFD were sent for observation to a perinatal psychologist for personalized correction of the psychological state, which allowed specifying and levelling the identified problems.
According to the results of the study of the psycho-emotional state of pregnant women, it can be concluded that women with a history of IFD have deviations at the level of situational and personal anxiety and the prospect of pathological childbirth dominant formation. Given the above results of the study, we recommend all women at risk of intrauterine fetal death and pregnant women with a history of intrauterine fetal a consultation with a perinatal psychologist at the pre-pregnancy stage and during pregnancy. And not only with the pregnant woman but also with family partners to prevent complications.