EP21.27: Reducing intrusive memories after early pregnancy loss using a brief cognitive task involving Tetris computer gameplay: a randomised controlled trial

Abstract

Objectives: To evaluate clinical factors prior to methotrexate (MTX) treatment for tubal ectopic pregnancy, and to apply the data to a prediction model for treatment success. Methods: This is a retrospective study of data recorded in a single tertiary medical centre during 2014-2022. Of 1,040 women with available data who presented with an ectopic pregnancy, 808 presented with a tubal ectopic pregnancy. Among them, 372 with a β-hCG level less than 5000 IU/L were treated with a single dose of 50 mg/m2 MTX and were included in this study. Pretreatment factors including patient characteristics, gestational age, initial β-hCG level, and sonographic parameters were compared between those who achieved complete resolution with the protocol and those who needed either an additional MTX dose or surgical intervention. A logistic regression model and multivariable analysis were employed to predict success. A graphic nomogram was generated to represent the logistic regression model. Results: Complete resolution of the ectopic pregnancy was achieved in 290 women (77.9%). A second dose of MTX or surgical intervention was required for 82 (22.0%): 49 (13.2%) received a second dose of MTX and 33 (8.9%) underwent laparoscopic salpingectomy. Based on significant variables identified by the multivariable logistic regression, the predictive model encompasses initial β-hCG concentration and the visibility of a yolk sac or fetal pole. Analysis with cross-validation techniques revealed that the model was both accurate and discriminative. Conclusions: A predictive nomogram incorporating three variables that are ascertainable during the initial assessment of tubal ectopic pregnancy was developed for predicting the success of single-dose MTX treatment. The nomogram provides a personalised graphic tool to aid clinicians in decision-making. EP21.27 Reducing intrusive memories after early pregnancy loss using a brief cognitive task involving Tetris computer gameplay: a randomised controlled trial Objectives: Early pregnancy loss (EPL) can be psychologically traumatic leading to distressing intrusive memories of the trauma. This study assesses the efficacy of a brief cognitive intervention (memory reminder and Tetris computer gameplay using mental rotation) in reducing intrusive memories of trauma 1 week following EPL compared to an active control group. Methods: Women were recruited from the early pregnancy unit in a West London hospital following a diagnosis of EPL (miscarriage or ectopic pregnancy). Participants were randomised to the intervention (brief memory reminder procedure, Tetris gameplay and mental rotation) or control task (listening to a podcast) in a 1 to 1 ratio. Participants completed the task during a follow up video call within 72 hours of discharge from EPL treatment/follow up. The frequency of intrusive memories was recorded daily for 1 week after task completion in an electronic 'flashback' diary. Between-group differences were tested using a two-tailed t-test (α=0.05) and cohen's d effect sizes were calculated. Secondary outcomes (frequency of intrusive memories, PTSD, anxiety, depression and functional impairment) were measured using validated tools at 1 and 3 months but are not reported in this abstract. Results: 146 of 168 recruited women were randomised with 69 and 72 completing the intervention and control tasks respectively. 135 participants returned the week 1 'flashback' diary. Significantly fewer intrusive memories (38% p = 0.03) were reported by the intervention group (mean 9.87, SD 11.36) than control group (mean 16.12, SD 21.27), with a treatment effect size of d=-0.36 (95% CI-0.7 to-0.02). Conclusions: We have shown that a brief cognitive intervention involving Tetris computer gameplay resulted in fewer intrusive memories at 1 week post-completion of EPL follow up/treatment. Further analysis is required to assess the long-term impact of the intervention on intrusive memories and mental health problems associated with EPL such as post-traumatic stress disorder. EP21.28 Tubal ectopic pregnancies: what the scan describes and histology finds Objectives: Ectopic pregnancies (EPs) can be particularly difficult to accept if they appear to be developing normally anatomically. Patients can ask if an EP, especially with a fetal pole, can be transplanted into the uterus. We examined whether the presence of a measurable Crown-rump length (CRL) on scan predicted the finding of fetal parts at histology. Methods: Retrospective observational review of electronic ultra-sound and results databases in a tertiary referral early pregnancy unit. Scan details of all patients with a confirmed tubal EP were compared with histology findings, where available, from 1st January 2018-31st July 2023. Results: Scanning diagnosed 1420 EPs, representing 896 pregnancies. 438/1420 (30.8%) EPs were surgically managed and histology was available. A CRL was measurable in 75/438 (17.1%) pregnancies. The median CRL was 4.1mm (Range 0.9-27.6). Fetal parts were found in 23/438 (5.0%) pregnancies; 16/22 (72.7%) with CRL, 6/363 (1.7%) without CRL. A measurable CRL on scan was associated with identification of fetal parts at histology [p < 0.01, χ2 test; p < 0.01. Sensitivity 72.7 (95% CI 52.3-88.1), Specificity 85.8 (82.2-88.9), PPV 21.3 (13.1-31.5), NPV 98.3 (96.7-99.3)]. The Odds Ratio of finding fetal remains if a CRL was measured was 16 (95% CI 6.1-42.9). Conclusions: Most of the EPs diagnosed did not have a measurable CRL. If present, a fetal pole significantly increased the likelihood of finding fetal parts at histology. The numbers of EPs with a CRL and the size range of these CRLs is small. We are expanding our search to see if the trends demonstrated are consistent across larger numbers and bigger CRLs. Knowledge that fetal parts are identifiable in only 5% EPs may be helpful in counselling patients about the abnormal implantation site of their pregnancy. Ms YFN, a 29-year-old in her 3rd pregnancy with a history of one previous miscarriage and a wedge resection of a cornual