Author(s): Kaltreider NB, Goldsmith S, Margolis AJ
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Abstract We studied 250 midtrimester abortions by dilatation and extraction (D and E) under general anesthesia and compared them with abortions by the intra-amniotic injection of prostaglandin (amnio) in order to assess the physical and emotional changes experienced by patients and staff under the different circumstances represented by each procedure. We found patients undergoing D and E abortions had fewer physical complications and described the procedure as minor surgery which went smoothly. The patients who had amnio abortions had more pain and reacted with more anger and depression afterward. Nurses were more disturbed by amnio abortions in which they played major roles in supporting the patient as well as in her abortion. Physicians reported the D and E procedures to be emotionally difficult which may limit the adoption of this procedure despite its value to patients. PIP: A comparison was made between the physical and emotional changes experienced by patients, nursing personnel, and physicians with 2 different mid-trimester abortion techniques. 250 dilatation and extraction (D and E) procedures under general anesthesia were compared with abortions by intraamniotic injection of prostaglandins. The only major difference between the 2 sets of patients was that the amnio patients were further along in their pregnancies. At a 3-week follow-up interview, the patients differed significantly in their reactions. The D and E group had fewer complications and described the procedure as minor surgery which went smoothly. The amnio group had experienced more pain and had greater feelings of guilt, anger, and depression. The floor nursing personnel felt anger at being abandoned by the doctors to deal alone, usually in the middle of the night, with the difficult experience of an amnio delivery of a dead fetus. Operating room nurses and doctors found the D and E procedure distasteful and emotionally disturbing. Doctors perferred to perform amnio procedures and not be involved at the time of delivery. The authors' experience leads them to conclude that the D and E procedure is safer, less painful, quicker, more convenient, and less expensive for the patient than the amnio procedure. The psychological problems doctors experience with dismemberment of the fetus may be relieved with development of new techniques.
This article was published in Am J Obstet Gynecol
and referenced in Journal of Depression and Anxiety