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GPs advised to follow-up women after early pregnancy bleeding assessment

GPs should offer routine follow-up appointments to all women referred for an ultrasound  assessment after pain and/or bleeding in early pregnancy, concludes a UK study

The study

Researchers from an urgent ultrasound clinic assessed questionnaires from 57 pregnant women under 16 weeks gestation referred by their GP with pain and/or bleeding.

The findings

They found fifty-four women of the 57 had a clinical diagnosis, with 33 women having a viable pregnancy and 21 a non-viable pregnancy (miscarriage). Fewer than one in 10 women who attended the gynaecology clinic had follow up appointments with their GP organised.  Of those who completed the first questionnaire, 10 out of 57 (17%) had, or planned to have, a GP appointment to discuss outcomes, 21 women out of 57 (37%) thought an appointment might be helpful, of which 12 women had a viable pregnancy and 9 women had a miscarriage;  two women (4%) thought it will not be helpful; the rest were not sure or ambivalent. Of the 47 women who had not seen or did not plan to see their GP, 13 (28%) thought seeing their GP might be helpful.

Mental health questionnaires were filled by all women in the study.  At the time of the first questionnaire, 35% (20 out of 57) had significant symptoms of distress as assessed by PHQ-9, GAD-7 and IES-R. However, none of these women had follow-up arrangements with their GP and only three were planning to see their GP afterwards. Significant anxiety symptoms above the ≥10 cut-off were present in 12 out of the 57 women (21%) which is almost three times greater than in the general population (6.7%).

What does it mean for GPs?

Although the study had a small number of respondents, the authors said it provided insight into the needs of women referred for ultrasound assessment of pain and/or bleeding in early pregnancy. The authors suggested ‘a change in current primary care practice’ and concluded: ‘GPs should consider routinely offering follow-up to all women who arereferred for assessment of pain and/or bleeding in early pregnancy. It might be easiest to make this offer at the time of referral. Women can choose to take up the offer if they feel it would be helpful.’

BMJ Open 2013, online 11 Apr



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