Posttraumatic stress disorder after second-trimester medical termination of pregnancy

To evaluate the risk of posttraumatic stress disorder after indicated second-trimester termination of pregnancy and to identify factors associated with a probable diagnosis of severe posttraumatic stress disorder.

Secondary analysis of a multicenter randomized controlled trial comparing the efficacy of cervical dilators inserted concurrently with misoprostol with that of misoprostol alone for women undergoing termination of pregnancy between 15^0/7 and 27^6/7 weeks of gestation. Posttraumatic stress disorder was evaluated by the Impact of Event Scale-Revised questionnaire, self-administered 1 to 4 months after termination of pregnancy. This 22-item scale is designed to assess subjective distress caused by traumatic events and has been validated in perinatal care. The literature suggests that a score ≥33 indicates a probable diagnosis of posttraumatic stress disorder and a score ≥37 a probable diagnosis of severe posttraumatic stress disorder. Maternal and obstetric characteristics associated with a score ≥37 were studied with mixed models. We present results after multiple imputation to take selective dropouts and missing information at follow-up into account and for complete cases.

Among the 347 women enrolled, 247 (71.2%) Impact of Event Scale-Revised questionnaires were available. Median time between termination of pregnancy and completion of the questionnaire was 7 weeks (interquartile range, 4.9-13.3). The mean Impact of Event Scale-Revised score was 32.1 (standard deviation, 15.4). The Impact of Event Scale-Revised score was ≥33 for 44.9% (95% confidence interval, 38.4-51.4) of women and ≥37 for 35.8% (95% confidence interval, 29.7-41.8). After multivariate analysis, obstetric or labor-related characteristics such as parity, gestational age over 22 weeks, use of cervical dilators, labor >12 hours, and pain or complications during delivery or postpartum were not associated with an Impact of Event Scale-Revised score ≥37. The results were similar in complete cases.

Nearly half of women undergoing medically indicated second-trimester termination of pregnancy were at risk of posttraumatic stress disorder and more than one-third of severe posttraumatic stress disorder. The absence of risk factors underlines the potential benefits of systematic psychological evaluation after termination of pregnancy for all women.