lt is, however, proposed that CG may be given official recognition in the fifth edition of the Diagnostic

and Statistical Manual of Mental Disorders.16 Adjustment after bereavement has been empirically shown to occur check details through a sequence of stages in a longitudinal study of bereaved individuals.17 This study revealed that in normal grieving, negative grief indicators such as disbelief, yearning, anger, and depression peak within approximately 6 months of loss. Lin and Lasker found a similar grief process in a study that looked specifically at bereaved parents after pregnancy loss.18 In this study, grief scores were initially relatively high and declined most steeply over the first year. In a 2-year follow-up Inhibitors,research,lifescience,medical their evaluation of Inhibitors,research,lifescience,medical the grief

process showed an interesting result: whilst 41 % of participants showed a normal decline of grief scores, the remaining 59% showed different patterns of pervasive presence or delayed resolution of grief. CG reactions after perinatal loss can be generally specified within the existing diagnostic criteria, but they differ from grief after other significant losses in a number of key aspects. A consistent feeling of guilt is commonly experienced after pregnancy loss and is associated with CG reactions.8,19,20 Self-blame Inhibitors,research,lifescience,medical may prolong the normal grieving process, especially if there was a feeling of ambivalence towards the pregnancy21 or if the subject perceives having done something wrong (eg, smoking or Inhibitors,research,lifescience,medical jogging during pregnancy). Another unicpe aspect of pregnancy loss is that women feel that their bodies have failed, and that their femininity has been undermined.20 Women who have already suffered a miscarriage show higher levels of psychological distress than women who have not experienced perinatal loss.22 Sometimes “child envy”—the feeling of being envious of other people’s children—can be an issue for those who have been through perinatal Inhibitors,research,lifescience,medical loss. These women often struggle to make contact with friends or family members who have children or who are at the same stage of pregnancy as

that at which the loss was suffered. Difficulty coping with these feelings and continuous avoidance often leads to most isolation of these mothers. As pregnancy losses are typically sudden and unexpected, parents usually have no time to anticipate grief or prepare themselves for the change in situation. Unlike the death of other close family members, parents bereaved by a perinatal loss have few or no direct life experiences with the infant. The introduction of imaging techniques such as ultrasound and 3D presentations mean that the fetus is now more likely perceived as a baby than as a fetus,23,21 but studies evaluating the psychological effect of having viewed ultrasounds have reported discordant results. Whilst some studies report higher levels of grief in those who have seen the ultrasound image of the unborn child, especially in men,25 others found no relationship.