D. Newman MD CCFP, C. Nowry MD CCFP, R. Vairavanathan MD CCFP(EM), and D. Telner MD CCFP

1. D. Newman MD CCFP, C. Nowry MD CCFP, R. Vairavanathan MD CCFP(EM), and D. Telner MD CCFP Objective: To explore the psychosocial experiences of women who present to the Emergency Department with bleeding in early pregnancy. Introduction: Many women report dissatisfaction with medical care they receive at the time of miscarriage.1After miscarriage, 50% of women have depressive symptoms and 20-40% have symptoms of anxiety. 2-4 Counseling at the time of miscarriage has been shown to decrease grief and self-blame.5 Early pregnancy assessment clinics have been shown to increase the efficiency of diagnosis and management of miscarriage.6 This study focused on women’s experiences in the ED during first trimester bleeding, regardless of the outcome. • Recurrent significant themes were found in five areas: • Long wait times • Negative psychological experience • Feeling of being a low priority • Greater satisfaction with medical care vs. emotional support • Desire for additional resources Bleeding in Early Pregnancy: A Qualitative Study of Women’s Experiences in the Emergency Department Long Wait Times: “I felt that my wait time was truly inappropriate for what I was going through since I was in excruciating pain” (96) “When I had to follow up the next day it was really awful...they sent me for an ultrasound at the hospital...and I was sitting there the whole time cramping, bleeding and they just don’t even care,...way too long to sit in a chair when you’re uncomfortable and you’re emotionally stressed.” (1) Hypothesis: Women presenting to a busy, urban ED with bleeding in early pregnancy have emotional needs that are not being met. Negative Psychological Experience: “...if the staff would just recognize that the person is kind of in a bad place emotionally... there is a huge emotional component to this medical thing.” (1) Methods: Subjects: women presenting to TEGH ED, bleeding in <20 weeks gestation. Phone interviews approx 10 days after discharge from ED. Interviews were recorded, analyzed by manual coding for recurrent themes. Feeling of Being a Low Priority: “It would have been nice to feel like my problem was just as important as other people’s problems. I’d already had it in my head for a month prior to that that I was carrying a child...[it was] kind of like my child wasn’t as important as the children who are already [born]”(19) Results: 21 women were recruited; 16 completed the interview. Qualitative data analysis identified several areas of patient dissatisfaction. Desire for Additional Resources: Most women wished for more information after leaving the ED. Two women described their discharge instructions as vague and unclear. “it would be really nice to have a dedicated resource like the breastfeeding clinic.” (1) Conclusion:Womenpresenting to our ED have emotional needs that are not being met in the current model of care. We propose that a separate outpatient clinic dedicated to the care of women with first trimester complications could address many of these complex issues. Also, providing additional Information in the form of a point-of-care pamphlet would serve to further support the emotional needs of these women. Abbreviations: TEGH = Toronto East General Hospital ED = Emergency Department • References: 1. Freidman T. Women’s experiences of general practitioner management of miscarriage. Journal of the Royal College of General Practitioners. 1989; 39: 456-458. 2. Lok IH and Neugebaurer R. Psychological morbidity following miscarriage. Best Practice & Research Clinical Obstetrics and Gynecology. 2007; 21 (2): 229-247.3. NeugebauerR, Kline J, O’Connor P et al. Depressive symptoms in women in the six months after miscarriage. American Journal of Obstetrics and Gynecology. 1992; 166: 104-109.4. Freidman T and Gath D. The psychiatric consequences of spontaneous abortion. The British journal of psychiatry : the journal of mental science. 1989; 155: 810-813. 5. Nikcevic AV, Kuczmierczyk AR and Nicolaides KH. The influence of medical and psychological interventions on women’s distress after miscarriage. Journal of Psychosomatic Research. 2007; 63: 283-290. 6. Brownlea S, Holdgate A, Thou STP, and Davis GK. Impact of an early pregnancy service on patient care and Emergency Department presentations. Australian and New Zealand Journal of Obstetrics and Gynecology. 2005; 45:108-111.