The process of abortion involves removing the embryo or fetus from the uterus, which either causes or results in the fetus's death. The World Health Organization (WHO) defines a miscarriage as the early loss of a baby up to 23 weeks of pregnancy and weighing up to 500 g. It may also happen naturally as a miscarriage, or it can be purposefully produced using chemical, surgical, or other methods [1, 2]. Abortion is often used to describe a surgical operation that may be performed at any stage of a pregnancy. Termination of pregnancy occurs when the baby is deemed nonviable, which often occurs before twenty weeks of gestation, according to medical definitions. The overall rate of miscarriage is 12–15% of all clinically diagnosed pregnancies, and it increases with increasing mother age. [3] Every woman who has a miscarriage feels some level of sorrow, which is why it is considered a terrible occurrence. [4] Thirty percent to fifty percent of women report anxiety symptoms, and ten percent to fifteen percent report depression symptoms after a miscarriage, with the latter group often enduring for at least four months. Some have proposed that these signs and symptoms represent a pattern of mourning after a child's birth loss. [3] In the beginning, when a woman feels cramps or bleeding, she may feel terrified and powerless since she thinks she is going to miscarry and cannot stop it. Typical grieving reactions to a spontaneous abortion include feelings of melancholy, rage, disbelief, anxiety, depersonalization, disturbed sleep, and exhaustion. [5] Because there are often no definitive medical reasons for early pregnancy loss, the woman may feel guilty and blame herself, wondering what she did wrong during the pregnancy. [6] The woman's relationships with her husband and children may suffer, and she may have persistent emotions of shame, inadequacy, and dread if she is not allowed to cope with her loss. [7] There is little evidence supporting psychological treatment of miscarriage compared to physical management, which has received a lot of attention. It may be possible to detect women who are at risk or who have already had psychological difficulties by following up with them after a miscarriage. By doing so, healthcare providers may better understand women's needs and provide treatments that improve their mental health and lessen the impact of miscarriage on their relationships. [9]

Objectives of this study:

To assess the psychological problems consequence to the Spontaneous abortion for aborted women, and association between the psychological problems consequence to the Spontaneous abortion and certain variables.

Participants in this descriptive research were women who had undergone a spontaneous abortion and were seeking treatment at one of three outpatient clinics in Baghdad: AL-Elwiyah Maternity Teaching Hospital, Baghdad General Teaching Hospital, or AL-Karhk Teaching Hospital.One hundred (100) women who had abortions and were seeking therapy at an outpatient clinic were included in the non-probability sample, also known as a purposive sample. After researching relevant literature, clinical background, and prior experiments, the investigator developed and built the instrument. There were five primary sections to the questionnaire: demographics, reproductive health, medical history, surgical procedures, and psychological issues related to the spontaneous abortion. After gaining each participant's consent in accordance with the inclusion criteria, data were gathered by interviews and self-report methodologies. Some examples of statistical methods include the chi-square test, relative sufficiency, contingency coefficients, and descriptive statistics like percentages and frequencies.

Table (1):Distribution of the study sample according to socio - demographic characteristics

Table 1 shows that the highest percentage (26%) of the study sample is in the age group (35-339) years. 

Concerning Years of Marriage: The highest percentage (29%%) of study sample marriage for (10-14) years.

Regarding if the study sample is the lonely wife: The highest percentage (90%) of study samples were the lonely wife. Regarding the residency: The highest percentage (86%) of the study sample was selected from urban residents. Regarding socio-economic status, the highest percentage (57%) of the study sample's socio-economic level was moderate.

 Table (2): Distribution of the study sample according to the reproductive Informations

The majority of the participants in the research fell within the 11–12 year old age bracket, as seen in Table (2). Regarding Age at Marriage: The age range of 20–24 years accounted for 40% of the research population. The majority of the participants in the research had modest menstrual amounts (77%). When looking at the number of pregnancies, 31% of the sample has three to four babies, while 43% of the sample has one to two live children. In terms of the total number of abortions and stillbirths, the research found that 65% of the samples had one abortion and 78.3% had one stillbirth. When it came to the methods of birth control, the majority of the study's participants (61.8%) used a combination of hormonal and non-hormonal methods, while the number of participants who used a single method was the greatest (68%).

            Table (3): Distribution of the study sample according to the Medical conditions

^(*) HS: Highly Sig. at P<0.01; S: Sig. at P<0.05; NS: Non Sig. at P>0.05; Testing based on Binomial test.

Table (3) shows that rather than most of studied sample's responding are registered no suffering of medical condition with highly significant differences at P<0.01 compared with who have, but it doesn’t means that studied sample are not attendance with health problems, and that especially with suffering of polycystic ovary were accounted (34%), then followed with high blood pressure (31%), followed with who had increasing or decreasing in weight (24%) , and abnormal inherited characteristics (16%) then followed with diabetes Mellitus and kidney problems (15%) respectively, Incidence of Thyroid disorders (12%), then followed with Cardiac problems (10%), then uterus problems (6%), immunity system disturbances (2%). While exposure to bacterial or virus infection was accounted for (38%) with significant differences at P<0.05, and finally, hormonal disturbances were accounted for (45%), with no significant difference at P>0.05.

Table (4): Distribution of the study sample according to the Surgical History

^(*) HS: Highly Sig. at P<0.01; S: Sig. at P<0.05; Testing based on Binomial test.

Table 4 shows that there were highly significant differences at P<0.01. Regarding vaginal test with surgical tool (65%), had previously done cervical dilatation (28%), had previously done internal surgical operation such as raising cervical polyp or partholean gland (11%), and finally had previously done curettage (61%), with significant differences at P<0.05. 

Table (5) : Distribution of the study sample according to the psychological problems subsequent to the Abortion

^(*) H: High assessment, M: Moderate assessment

Table (5) shows that there were highly significant differences at P<0.01 in most items of the psychological aspects except fear feeling, and item (being worried if there will be infertility in the future) related to the anxiety feeling and item (feeling carelessness in the affairs of the family) related to the depression feeling were moderately significant differences.

Table (6): Relationship concerning Psychological problems, Demographical Characteristics, and

Reproductive Informations 

^(*) NS: Non Sig. at P>0.05; Testing based on contingency coefficients.

Table (6) shows that there were with no significant at P>0.05 among  Psychological problems, Demographical Characteristics, and Reproductive Informations.

The survey found that the age group of 35–39 years accounted for the largest proportion of the sample (26%). The research group found that marriages lasting 10-14 years accounted for the largest proportion (29%).Whether the sample represents lonely women or not, the majority (90%) of the samples were indeed lonely wives. Regarding residency, the majority of the research sample, 86%, resides in cities. In terms of socioeconomic status, 57% of the people surveyed fell into the "moderate" category.

One powerful demographic determinant that affects maternal and infant health is the average age of the bride and groom. Findings from this research align with Slama R. et al. (2005) conducted research on the relationship between maternal age and spontaneous abortion, finding that mothers aged 35 and above had a higher probability of having an abortion. Higher incomes and lower levels of education were associated with a lower likelihood of spontaneous abortion. Kramer (2000) suggests that there is likely no direct correlation between educational attainment and socioeconomic level and spontaneous abortion. This study's findings support that theory. [11] Among the age groups studied, the one pertaining to menarche [11–12] accounted for the largest proportion (61%). Regarding Age at Marriage: The age range of 20–24 years accounted for 40% of the research population. The majority of the participants in the research had modest menstrual amounts (77%). When looking at the number of pregnancies, 31% of the sample has three to four babies, while 43% of the sample has one to two live children. In terms of the total number of abortions and stillbirths, the research found that 65% of the samples had one abortion and 78.3% had one stillbirth. When it came to the methods of birth control, the majority of the study's participants (61.8%) used a combination of hormonal and non-hormonal methods, while the number of participants who used a single method was the greatest (68%). Consistent with previous research, this study found that spontaneous abortion was more common in women who reached menarche at a younger age. Perhaps the same underlying endocrinologic features explain both early menarche and spontaneous abortion. On the other side, there's some evidence that early menarche is associated with an increase in spontaneous abortions, pelvic inflammatory illness, and sexual activity. [12] According to Small (2005), there seems to be an association between menstrual cycle features and fertility as well as spontaneous abortion. This study's findings corroborate that finding. [13] According to Ford and MacCormac, women who start a family after discontinuing oral contraception had a lesser chance of having a chromosomally normal spontaneous abortion because of trisomy, which occurs when ovulation is suppressed and the number of follicles is preserved. [14]

The study found that a significant portion of the sample did not have any medical conditions, with a p-value of less than 0.01. However, this does not imply that the sample is free from health issues. Specifically, 34% of the sample reported suffering from polycystic ovary, 31% from high blood pressure, 24% from weight changes, 16% from abnormal inherited traits, 15% from kidney problems, 12% from thyroid disorders, 10% from cardiac problems, 6% from uterus problems, and 2% from an immune system disturbance. At 38%, there were significant changes at P<0.05 due to exposure to infected bacteria or viruses, while at 45%, there was no significant difference at P>0.05 due to hormonal disruptions. Diabetes, polycystic ovarian syndrome (PCOS), hypothyroidism, some viral disorders, autoimmune diseases, and certain other co-occurring conditions during pregnancy might significantly heighten the chance of spontaneous abortion. Miscarriage is more likely in women with severe hypothyroidism. [15] There were extremely significant differences at a significance level of P<0.01, according to the research. The following groups showed significant differences at P<0.05: 65% of the participants had undergone vaginal testing with a surgical instrument, 28% had undergone cervical dilatation, 11% had undergone internal surgical procedures such as a rise of the cervical polyp or partholean gland, and 61% had undergone curettage. Some evidence in the literature suggests a potential correlation between certain factors and the likelihood of a spontaneous abortion. These factors include gravidity, parity, a history of ectopic pregnancies, abortions, elective terminations of pregnancies, pelvic surgeries, cesarean sections, pelvic inflammatory disease, gonorrhea, chlamydia, or intrauterine device use. [16] There is some evidence that dilating the cervix and curettage might increase the risk of complications during subsequent pregnancies, such as ectopic pregnancies, premature labor, premature membrane rupture, early newborn mortality, and incompetent cervix. [17]

The study revealed that most items related to psychological aspects exhibited highly significant differences, with a P-value of less than 0.01. However, the study found moderately significant differences in the feelings of fear, anxiety, and depression, as well as in the items related to worrying about future infertility and feeling careless in family affairs. Studies on women's mental health after spontaneous abortions reveal that many of them experience symptoms such as melancholy, anxiety, suicidal thoughts or actions, prolonged mourning, guilt, PTSD, traumatic stress disorder, sleep disturbances, and concerns about infertility. [18]

Results from the analysis of demographic information, reproductive details, and psychological issues did not reach statistical significance (P > 0.05). Previous results indicate that the research questionnaire on women's mental health after an abortion is applicable to the general population, despite potential variations in socio-demographic characteristics and reproductive health variables.

In accordance with the results of this study the researcher can conclude the following:

- More than quarter of the study samples are at age group (35 ــ 39) years.

- Approximately third of the study samples years of marriage are ranging between (10-14) years.

- More than half of the study samples their socio-economic level were Moderate.

- Approximately two thirds of the study samples sample their age of Menarche group (11 - 12) years.

- More than third of the study samples their age at Marriage group (20 - 24) years.

- Two third of the study samples have one abortion.

- Two third of the study samples have one abortion were used a contraceptive.

 - Most of studied sample's responding are registered no suffering of medical condition with highly significant     differences at P<0.01, but it doesn’t means that studied sample are not attendance with health problems, and that especially with suffering of polycystic ovary were accounted, then followed with high blood pressure .

- There were highly significant differences regarding previously doing vaginal test with surgical tool.

- There were highly significant differences in most items of the psychological aspects

- There were with no significant among Psychological problems, Demographical Characteristics, and Reproductive Informations.

1. The establishment of counseling clinic in all specialized hospitals for childbirth and Primary health care centers to give the woman an opportunity to express and understand her feelings after abortion and prevention and improve symptoms of post-traumatic stress disorder and other  psychological disorders after abortion.

2. Increase the women’s knowledge regarding reproductive anatomy and physiology, the methods of fertility control that are available to her and her partner following the abortion via mass media.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Al-Farabi University College Republic of Iraq Ministry of Higher Education and Scientific Research 

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