Examining psychometric screening scores for depression, anxiety, and posttraumatic stress after fetal KCL injection

To examine the incidence of positive screens for depression, anxiety, and posttraumatic stress among patients undergoing therapeutic abortion at ≥ 22 weeks' gestation.

This was a prospective, observational cohort study of patients undergoing fetal potassium chloride (KCL) injection for induced abortion at ≥ 22 weeks' gestation. All eligible patients were approached within 48 h of the scheduled termination. After obtaining informed consent, basic demographic information was collected. Patients completed the Edinburgh Postnatal Depression Scale (EPDS), General Anxiety Disorder-7 (GAD-7), and Primary Care Post-Traumatic Stress Disorder-5 (PC-PTSD-5) questionnaires three times, first prior to their KCL procedure and then again 2 and 12 weeks postprocedure. Consents and questionnaires were provided in both English and Spanish. Patients who scored positive on any tool were referred to an in-house social worker and connected to ongoing mental health care as appropriate.

A total of 53 patients were screened for this study, of whom 30 enrolled. The mean gestational duration at the time of enrollment was 24.7 weeks. Fetal anomaly was the indication for termination in 66.7% of patients. A total of 15 patients (50.0%) completed the 2-week follow-up surveys, and 9 patients (30.0%) completed the 12-week follow-up surveys. The median (IQR) baseline scores for the EPDS, GAD-7, and PC-PTSD-5 were 13 (11.3), 6.5 (6.5), and 0.5 (2), respectively. The median 2-week follow-up scores were 10 (5), 5 (4), and 2 (1), respectively, though these were not statistically significantly different from baseline. The median 12-week follow-up scores were 9(3), 4 (3), and 2 (2), respectively, and these were also not statistically significantly different from baseline. There was no difference in the proportion of patients who screened positively on any measures between those patients who completed the follow-up surveys and those who did not. There were also no differences in the proportion of positive screens by evacuation method or termination indication.

Most patients undergoing termination at ≥ 22 weeks' gestation at our institution during the study period did so for fetal anomalies. Our results are limited by low return rates for the follow-up surveys. More research is needed on the long-term mental health outcomes of patients undergoing termination after 22 weeks.