1. POSTER TEMPLATE BY: www.PosterPresentations.com A qualitative study on patients’ perception of expectant management of incomplete miscarriage PS Wijesinghe, RP Herath, PK Abeysundara Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Kelaniya, Sri Lanka Objectives Results Conclusions References Miscarriage is common gynaecological problem, affecting around one in six pregnancies 1. It is a distressing experience for women and their partners, which is not often adequately appreciated by the health care providers. Surgical evacuation of the uterus has been the conventional treatment of miscarriage 2. Recently the possibility of conservative management has been tried and tested 3. Expectant management is an effective and safe alternative to surgical evacuation for incomplete miscarriage before 14 weeks of gestation, confirmed by ultrasound with retained products of 15-50 mm in the maximum antero-posterior diameter of the endometrial cavity 4. But the patients’ perceptions and attitudes towards this mode of management are less clear. This Study was designed to understand the women’s perception of symptoms, acceptability, fertility wishes and care received. Better counseling on the natural course of events in spontaneous miscarriage will help not only the patient but also the relatives in accepting expectant management of first trimester miscarriage with regard to their ideas beliefs and feelings. Improved health education, counseling, and symptomatic relief are important aspects in improving the overall quality of care. Methods A qualitative study among 25 women who were undergoing expectant management for incomplete miscarriage was carried out at the University Gynaecology Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka. Women were recruited at the initial diagnosis of incomplete miscarriage and interviewed at the end of two weeks of expectant management. The interview was based on five principal themes; Bleeding and pain Ideas, beliefs and feelings regarding the intervention Patient’s preferred treatment method in a possible future event Fertility wishes Perceived care received during the time of admission Interviews were recorded using a digital voice recorder, and subsequently transcribed and translated in to English. Characteristics of the study population is described in Table1. Majority of women experienced heavy bleeding and pain, which were worse than a normal menstrual period. For women who were employed, duration of symptoms was the main factor, which determined their perceptions regarding bleeding and pain. Many preferred expectant management and were satisfied with the mode of management. Ideas and beliefs of the mother, husband, mother in law, and other patients in the ward influenced most of women experiencing a miscarriage. Majority preferred the same mode of management in a possible future event while few of them preferred medical evacuation. Many expected to conceive again but preferred to delay it even in the absence of any contraindication. However, few of them completely gave up hopes. Inadequate knowledge of the principles of expectant management led to dissatisfaction regarding the care received during admission. Bleeding and pain Ideas, beliefs and feelings regarding the intervention “I felt the same severe pain one feels while having contractions and it kept on getting worse. I bled slightly for about a week. The doctor told me that everything was fine. I suffered a lot and got severe cramps. ” “I think it is better than performing an operation. There was nothing left inside to remove according to the doctor. My mother in law said that if I under went surgery, I will have miscarriages repeatedly and will end up repeated surgeries.”. “There was slightly more bleeding compared to my menstrual periods. But it was acceptable.” “It would’ve been better if some kind of treatment was used to remove the dead tissues at the time of the diagnosis was made, without wasting time.” Patient's preferable treatment method in a future event “Every thing was fine as long as it’s expelled naturally. I think this method is suitable. It was painless after all. It’s like this, people who talked to me said that they can’t become pregnant since they underwent surgery to remove retained fetal tissues. I wish to have a baby soon. I would prefer a less risky method like this” Fertility wishes “Oh my gosh! No way! I don’t want babies anymore. I’ve been through enough.” “We are hoping to but not now. I’m still a little bit scared to think about it.” Perceived care received during the time of admission “I was a little annoyed. I was here for about two days. Apart from paracetamol tablets, no medicines was given, and nothing to stop bleeding” Statements made by the study subjects were categorized under five main themes Table1 CharacteristicNumber Age(years) 20-2506 26-30 10 31-3507 36-40 01 41-4501 Education A/L or Higher education12 O/L08 Grade 05-1004 Grade 01-0501 Religion Catholic13 Buddhists12 Characteristic Number Occupational status Employed14 Un employed11 Family system Nuclear family19 Extended family06 1.Everett C. Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice. British Medical Journal. 1997; 315:32–34. 2.El-Sayed MM, Mohamed SA, Jones MH. Expectant management of first- trimester miscarriage. Journal of Obstetetrics and Gynaecology. 2009 ; 29(8):681-5. 3.Hinshaw K, Fayyad A, Munjuluri P. The management of early pregnancy loss. Green top guide lines No. 25. 2006 4. Wijesinghe PS, Padumadasa GS, Palihawadana TS, Marleen FS. A trial of expectant management in incomplete miscarriage. Ceylon Medical Journal. 2011; 56: 10-13 “I was told that the fetal tissue has not completely passed. Hence, the doctor asked to get admitted to the hospital for a womb wash. A girl undergoing treatment in that ward said that the dead baby would be removed by using capsules. Therefore, I thought they‘d do the same for me. That is what they had done for that girl.” Recommendation