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Richardson, Alison and Raine-Fenning, Nick and Deb, Shilpa and Campbell, Bruce and Vedhara, Kavita (2016) Anxiety associated with diagnostic uncertainties in early pregnancy. Ultrasound in Obstetrics & Gynaecology . ISSN 1469-0705

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Abstract

Objectives: To determine anxiety levels of women presenting to Early Pregnancy Assessment Units (EPAU) with abdominal pain and/or vaginal bleeding and assess how these change over time and according to ultrasonographic diagnosis.

Methods: We undertook a prospective cohort study in a EPAU in a large UK teaching hospital. Women with abdominal pain and/or vaginal bleeding in early pregnancy (less than 12 weeks gestation) presenting for the first time were eligible for inclusion in the study. State anxiety levels were assessed using the standardised short form of Spielberger's state-trait anxiety inventory on three occasions (before, immediately after and 48–72 hours after an ultrasound scan). Scores were correlated with ultrasonographic diagnosis. The diagnosis was either certain or uncertain. Certain diagnoses were either positive i.e. a viable intrauterine pregnancy (IUP), or negative i.e. a non-viable IUP or ectopic pregnancy (EP). Uncertain diagnoses included pregnancies of unknown location (PUL) and uncertain viability (PUV). Statistical analysis involved mixed ANOVAs and the post-hoc Tukey-Kramer test.

Results: 160 women were included in the study. Anxiety levels decreased over time for women with certain diagnoses (n = 128), even when negative (n = 64), and increased over time for women with uncertain diagnoses (n = 32). Before the ultrasound, anxiety levels were high (21.96 ± 1.11) and there was no significant difference between the five groups. Immediately after the ultrasound, anxiety levels were lower in the viable IUP group (n = 64; 7.75 ± 1.13) than any other group. The difference between the five groups was significant (p < 0.005). 48–72 hours later, women with certain diagnoses had significantly lower anxiety levels than those with uncertain diagnoses (10.77 ± 4.30 vs 22.94 ± 1.65: p < 0.005).

Conclusions: The experience of abdominal pain and/or vaginal bleeding in early pregnancy is highly anxiogenic. Following an ultrasound, the certainty of the diagnosis affects anxiety levels more than the positive or negative connotations associated with the diagnosis per se. All healthcare providers should be aware of this when communicating uncertain diagnoses.

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