Henrietta D.L. Ockhuijsen

Coping after recurrent miscarriage: uncertainty and bracing for the worst

Background The aim of this study was to understand how women with single or recurrent miscarriages cope during the waiting periods after miscarriage – waiting for pregnancy or waiting for pregnancy confirmation – and to investigate their perception of a ‘positive reappraisal’ coping intervention designed for these waiting periods. Positive reappraisal is a cognitive strategy to change the meaning of a situation, specifically reinterpreting the situation in a more positive way. Methods A qualitative methodology was used. Data were obtained from two focus groups comprising nine women with one or more miscarriages. Results Two core categories, ‘uncertainty’ and ‘bracing’, were highlighted during the waiting period for confirmation of an ongoing pregnancy. Women who had experienced a single miscarriage appraised this waiting period as benign and used distraction and coping by social support. Women with recurrent miscarriages could not confidently appraise the waiting period as one that would bring hope or joy and used bracing for the worst as their coping strategy to manage this ambivalence. With this strategy, women tried to control their current emotions, and looked into the future to try to minimise their distress if a further miscarriage occurred. Although all women thought that a ‘positive reappraisal’ coping intervention would be practical and applicable during waiting periods, only women with recurrent miscarriages actually wanted to use such an intervention. Conclusions Coping interventions targeting reappraisal of the waiting period stressor situation could help women to cope as they wait for a subsequent pregnancy to be confirmed as ongoing. Coping interventions may need to be tailored, but before any strategy is introduced, further study is needed to identify the most appropriate approach.

The PRCI study: design of a randomized clinical trial to evaluate a coping intervention for medical waiting periods used by women undergoing a fertility treatment

BackgroundMany medical situations necessitate a stressful period of waiting for potentially threatening test results. The medical waiting period is often associated with negative anticipatory anxiety and rumination about the outcome of treatment. Few evidence-based self-help coping interventions are available to assist individuals manage these periods. Theory and research suggest that positive reappraisal coping strategies may be particularly useful for this type of unpredictable and uncontrollable stressful context. The objective of this study is to investigate the effects of a Positive Reappraisal Coping Intervention (PRCI) on psychological well-being of women waiting for the outcome of their fertility treatment cycle.Methods/DesignIn a three-armed randomized controlled trial, the effectiveness of the PRCI will be tested. Consecutive patients undergoing in vitro fertilisation in a Dutch university hospital and meeting selection criteria will be invited to participate. Those who agree will be randomized to one of three experimental groups (N=372). The PRCI Intervention group will receive the intervention that comprises an explanatory leaflet and the 10 statements designed to promote positive reappraisal coping, to be read at least once in the morning, once in the evening. To capture the general impact of PRCI on psychological wellbeing patients will complete questionnaires before the waiting period (pre-intervention), on day ten of the 14-day waiting period (intervention) and six weeks after the start of the waiting period (post-intervention). To capture the specific effects of the PRCI during the waiting period, patients will also be asked to monitor daily their emotions and reactions during the 14-day waiting period. The primary outcome is general anxiety, measured by the Hospital Anxiety and Depression Scale. Secondary outcomes are positive and negative emotions during the waiting period, depression, quality of life, coping and treatment outcome. During recruitment for the RCT it was decided to add a fourth non-randomized group, a PRCI Control group that received the PRCI and completed the questionnaires but did not complete daily monitoring.DiscussionPositive reappraisal is one of the few ways of coping that has been shown to be associated with increased wellbeing during unpredictable and uncontrollable situations like medical waiting periods. A simple evidence based self-help intervention could facilitate coping during this common medical situation. This RCT study will evaluate the value of a self-help coping intervention designed for medical waiting periods in women undergoing fertility treatment.Trial registrationThe study is registered at the Clinical Tials.gov (NCT01701011).

Clarifying the benefits of the positive reappraisal coping intervention for women waiting for the outcome of IVF

STUDY QUESTION Does the use of a positive reappraisal coping intervention (PRCI) alone following IVF embryo transfer influence anxiety, the depression and treatment outcome when compared with its use combined with monitoring emotions, monitoring emotions alone or no intervention? SUMMARY ANSWER Woman using the PRCI alone had significantly lower anxiety levels at Day 10 of the waiting period and 6 weeks after the start of the waiting period but also a significantly higher clinical pregnancy rate compared with the other three groups. WHAT IS KNOWN ALREADY The waiting period, which follows embryo transfer after IVF/ICSI is very stressful. The use of the PRCI together with a daily monitoring form increases positive emotions but appears not to reduce anxiety. The impact of using the PRCI without daily recording of emotions may be more beneficial. STUDY DESIGN, SIZE, DURATION Following completion of recruitment to a recently published 3-arm randomized controlled trial (RCT) of the use of the PRCI in the post-embryo transfer waiting period, a further 110 participants were recruited to study the impact of the PRCI in clinical practice without concurrent emotional monitoring. Data collection took place between May 2012 and December 2012. Outcomes were compared with those generated by a RCT of the PRCI with daily emotional monitoring, daily emotional monitoring only or routine care. PARTICIPANT, MATERIALS, SETTING, METHODS To capture the impact of the PRCI on this further group, questionnaires were completed at three time points: just before the waiting period (Time 1: preintervention), on Day 10 of the 14-day waiting period (Time 2: waiting period intervention) and 6 weeks after the start of the waiting period (Time 3: post-intervention). Data generated were compared with the data from the RCT. To compare the impact over time on anxiety and depression, a repeated multilevel linear model design was used. MAIN RESULTS AND THE ROLE OF CHANCE Nighty-eight of the 110 women who were recruited received the PRCI intervention without daily monitoring (PRCI-comparison group). After correcting for known confounding factors, compared with women in all three groups of the original RCT, women in the PRCI-comparison group had a significantly lower anxiety at Time 2 (n = 83) and Time 3 (n = 70) but not significantly lower depression levels. Women in the PRCI-comparison group had a significantly higher clinical pregnancy rate (39.8%, P = 0.033) but there were no significant differences in clinical pregnancies with fetal heartbeat (P = 0.10). LIMITATIONS, REASONS FOR CAUTION A limitation of this study is that the additional study group was not randomized to the intervention, and may therefore be subject to selection bias. The study was also done subsequent to the other three groups. WIDER IMPLICATIONS OF THE FINDINGS This simple low cost self-help coping intervention can be offered to women during the waiting period in an IVF/ICSI treatment. A further RCT comparing PRCI only to a non-intervention group is necessary to confirm these findings. STUDY FUNDING/COMPETENT INTERESTS The Women and Baby Division of the University Medical Centre Utrecht funded the study. The authors have no conflicting interest(s).

Systematic review found that there was moderate evidence that vaccinating healthcare workers prevented pertussis in infants

This systematic review investigated the effectiveness of vaccinating healthcare workers against pertussis on the occurrence of nosocomial pertussis outbreaks or infections among unprotected infants. We focused on eight studies, with five different study designs, that involved 39,129 healthy adolescents and adults, 115 healthcare workers, 2000 simulated healthcare workers and a simulated population of 200,000 people.

Validation study of the SCREENIVF : An instrument to screen women or men on risk for emotional maladjustment before the start of a fertility treatment

OBJECTIVE To examine construct and criterion validity of the Dutch SCREENIVF among women and men undergoing a fertility treatment. DESIGN A prospective longitudinal study nested in a randomized controlled trial. SETTING University hospital. PATIENT(S) Couples, 468 women and 383 men, undergoing an IVF/intracytoplasmic sperm injection (ICSI) treatment in a fertility clinic, completed the SCREENIVF. MAIN OUTCOME MEASURE(S) Construct and criteria validity of the SCREENIVF. RESULT(S) The comparative fit index and root mean square error of approximation for women and men show a good fit of the factor model. Across time, the sensitivity for Hospital Anxiety and Depression Scale subscale in women ranged from 61%-98%, specificity 53%-65%, predictive value of a positive test (PVP) 13%-56%, predictive value of a negative test (PVN) 70%-99%. The sensitivity scores for men ranged from 38%-100%, specificity 71%-75%, PVP 9%-27%, PVN 92%-100%. A prediction model revealed that for women 68.7% of the variance in the Hospital Anxiety and Depression Scale on time 1 and 42.5% at time 2 and 38.9% at time 3 was explained by the predictors, the sum score scales of the SCREENIVF. For men, 58.1% of the variance in the Hospital Anxiety and Depression Scale on time 1 and 46.5% at time 2 and 37.3% at time 3 was explained by the predictors, the sum score scales of the SCREENIVF. CONCLUSION(S) The SCREENIVF has good construct validity but the concurrent validity is better than the predictive validity. SCREENIVF will be most effectively used in fertility clinics at the start of treatment and should not be used as a predictive tool.

Exploring a self-help coping intervention for pregnant women with a miscarriage history

Pregnant women with a history of miscarriages experience symptoms of anxiety and depression in a subsequent pregnancy and are in need of support in the period after miscarriage, when trying to get pregnant again and during the first phase of pregnancy. The aim of this study was to investigate whether a Positive Reappraisal Coping Intervention (PRCI) and Daily Record Keeping (DRK) chart, developed for use in assisted conception treatment, are also appropriate for use in pregnant women with a history of miscarriage(s). In this convergent parallel mixed method study, thirteen women visiting an Early Pregnancy Unit and/or Recurrent Miscarriage Clinic in a university medical center in the Netherlands were selected on the basis of the number of miscarriages and age. Exclusion criteria were not speaking the Dutch language, pregnancy after fertility treatment and having a medical cause identified for the miscarriages. Women used the PRCI and DRK for 3 weeks in a subsequent pregnancy. Quantitative data were obtained from the DRK and were analyzed by reporting frequencies and means for each case. Qualitative data were collected by semi-structured interviews and were analyzed by using thematic analysis. The majority of the women were able to use the PRCI and DRK for 3weeks. Women adapted the way in which they used the PRCI and DRK based on their judgment about the effect, the intensity of the emotions they experienced, or whether they felt the effort to use these instruments to be worthwhile or not.