TOPLINE:

Among women who underwent a medically indicated second-trimester termination of pregnancy, nearly half had posttraumatic stress disorder (PTSD), and more than one third had severe PTSD based on assessment of symptoms. No maternal, obstetric, or labor features were associated with severe PTSD.

METHODOLOGY:

• Researchers performed a secondary analysis of a multicenter randomized controlled trial to assess the risk for PTSD after second-trimester termination of pregnancy.
• They included 347 women (median maternal age, 33 years) from 2017 to 2019 who underwent medically indicated termination of pregnancy between 15 weeks and 27 weeks gestation. Indications were either a high probability of a severe, incurable fetal disease or a maternal condition that made continuing the pregnancy a threat to maternal health.
• Interventions were misoprostol plus cervical dilators or misoprostol alone; all patients received epidural analgesia, and from 22 weeks of gestation, fetal demise was induced using midazolam and lidocaine injection.
• PTSD symptoms were assessed using the 22-item Impact of Event Scale-Revised (IES-R).
• Overall, 247 IES-R responses were available, of which 218 were complete. The median time from termination to questionnaire completion was 7 weeks.

TAKEAWAY:

• Overall, 44.9% (95% CI, 38.4-51.4) of the women had a score indicating PTSD, and 35.8% (95% CI, 29.7-41.8) had a score indicating severe PTSD.
• No significant associations were found between severe scores and maternal or obstetric variables, including parity, use of cervical dilators, labor duration, pain, complications, or the indication for termination of pregnancy.

IN PRACTICE:

“The absence of any identified risk factor suggests that the event is so intense that it exposes every woman, regardless of her sociodemographic or obstetric characteristics,” the authors of the study wrote. “These findings also emphasize the need for systematic PTSD screening after TOP [termination of pregnancy] and thus the importance of routine use of evaluation tools and postnatal follow-up to ensure appropriate psychological care.”

SOURCE:

The study was led by Olivia Anselem, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France. It was published online on February 20, 2026, in the American Journal of Obstetrics and Gynecology.

LIMITATIONS:

A comparable control cohort of women who continued their pregnancies with similar diagnoses and did not choose termination of pregnancy was absent. The rate of PTSD may have been affected by the exclusion of women who were socially deprived and did not have health insurance or those with a history of psychiatric disorders.

DISCLOSURES:

The study was supported by the French Ministry of Health and the Département de la Recherche Clinique et du Développement de l'Assistance Publique-Hôpitaux de Paris served as the sponsor. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.