Investigation of the cause of miscarriage and its influence on women's psychological distress

Objective To determine whether knowledge of the possible cause of miscarriage reduces women's long term psychological distress. Design Prospective longitudinal study. Setting Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London. Methods In 143 women where a routine ultrasound scan at 10-14 weeks of gestation showed an anembryonic pregnancy or fetal death, investigations were carried out to help ascertain the cause of the pregnancy loss. The participants were divided into two groups according to whether the cause was identified or not, and the psychological conditions of the two groups were compared at four weeks and four months after the diagnosis of fetal loss. Main outcome measures Anxiety, depression, grief, self-blame, worry. Results The scores for all outcome variables were significantly lower at the four-month compared with the four-week post-miscarriage assessment. A fetal chromosomal abnormality was the most commonly identified cause of miscarriage, and this group reported significantly less self-blame than women in whom no cause was identified. There were no significant differences between the groups on any other outcome variables. Conclusions In women with a missed miscarriage, identification of the cause of fetal loss reduces the feelings of self-blame.