issues also loom large, depending upon the pressures and circumstances of their lives. On occasion, there is an unwillingness to continue pregnancy when a partner has suffered from the same later onset disorder. Marital ambiguity about the abortion decision can dominate the process and destroy a relationship. Any argument should be relegated to the couple's home, with a request to return when a decision has been made.
The importance of continuing follow‐up visits with couples who have terminated pregnancy for fetal defects cannot be overemphasized. In an important study on the psychosocial sequelae in such cases, White‐van Mourik et al.992 showed the long‐range effects. Displays of emotional and somatic symptoms 1–2 years after abortion were not rare and included partners. Although some couples grew closer in their relationships, separations, especially because of failed communication, increased irritability, and intolerance, were noted in 12 percent of the 84 patients studied.993 Marital discord in these circumstances has been noted previously.993, 994 At least 50 percent of couples admitted to having problems in their sexual relationship. In addition, many couples indicated changed behavior toward their existing children, including overprotectiveness, anxiety, irritability, and subsequent guilt and indifference (Table 1.9).992 Women with secondary infertility and those younger than 21 years of age (or immature women) had the most prolonged emotional, physical, and social difficulties.992 After a loss of a child, with or without an anomaly, between 10 and 25 percent of distressed parents have disturbed emotional stability and adverse mental and physical health effects.995 Anticipated grief experienced by mothers, especially those faced with a third‐trimester diagnosis of a lethal fetal abnormality, requires psychological help with preparedness. Empathy and sensitivity are critical at these intensely painful times and mature counseling and nonjudgmental support are vital to help parents cope.
Table 1.9 The frequency of emotions and somatic symptoms of 84 women and 68 men: overall and 24 months after terminating a pregnancy for fetal abnormality.
| Overall | 24 months after termination | ||||
|---|---|---|---|---|---|
| Women (%) | Men (%) | Women (%) | Men (%) | ||
| Feeling | |||||
| Sadness | 95 | 85 | 60 | 47 | |
| Depression | 79 | 47 | 12 | 6 | |
| Anger | 78 | 33 | 27 | 7 | |
| Fear | 77 | 37 | 46 | 17 | |
| Guilt | 68 | 22 | 33 | 7 | |
| Failure | 61 | 26 | 24 | 14 | |
| Shame | 40 | 9 | 18 | 4 | |
| Vulnerability | 35 | 0 | 18 | 0 | |
| Relief | 30 | 32 | 16 | 16 | |
| Isolation | 27 | 20 | 11 | 6 | |
| Numbness | 23 | 0 | 0 | 0 | |
| Panic spells | 20 | 0 | 5 | 0 | |
| Withdrawal | 0 | 32 | 0 | 13 | |
| Left out | 0 | 12 | 0 | 0 | |
| Somatic symptom | |||||
| Crying | 82 | 50 | 22 | 5 | |
| Irritable | 67 | 38 | 19 | 3 | |
| No concentration | 57 | 41 | 7 | 1 | |
| Listlessness | 56 | 17 | 2 | 0 | |
| Sleeplessness | 47 | 19 | 2 | 1 | |
| Tiredness | 42 | 21 | 6 | 3 | |
| Loss of appetite | 31 | 10 | 0 | 0 | |
| Nightmares | 24 | 7 | 5 | 0 | |
| Palpitations | 17 | ‐ | 6 | 0 | |
| Headaches | 9 | 8 | 2 | ||
