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The UNSURENESS study.

by Fondazione CiaoLapo
written by Fondazione CiaoLapo

A pregnancy following a perinatal death is never “just another pregnancy.” It is a complex journey in which intense emotions – grief, fear, hope – and specific clinical needs are intertwined. Caring for these pregnancies requires attention, continuity, technical expertise and communication sensitivity.

Our new study, UNSURENESS (sUpportiNg subSeqUent pREgnaNcy after pErinatal loSS), published in Journal of Clinical Medicine, investigates how Italian health care providers deal with this challenge.

Why this study

Every year, hundreds of families in Italy experience a perinatal death. More than half undertake a new pregnancy within a year. In this context, the role of health professionals is crucial: accompanying parents means not only providing clinical oversight, but also recognizing and welcoming grief, building trust, fostering shared decision-making, and supporting psychological well-being.

Despite the existence of recommendations from scientific societies, Italy lacks binding national guidelines and structured pathways. The UNSURENESS Study was created to take a snapshot of the current situation and identify the main training and organizational needs.

How it was conducted

We conducted a national online survey (August 2023-February 2024) targeting health care providers dealing with pregnancy following perinatal bereavement.
Two hundred female professionals, mostly midwives, from all over Italy participated. The questionnaire explored professional experience, training received, communication approaches, and clinical management criteria.

What we found

  • Insufficient training: only one-third of the participants had received specific training on how to assist these pregnancies.
  • Priority aspects: addressing previous loss with parents, establishing a trusting relationship, sharing clinical decisions, and providing complete information.
  • Major challenges: managing parents’ fears and offering appropriate reassurance.
  • Decision criteria: continuity of care and respect for parental preferences were found to be more influential than guidelines or scientific evidence.
  • Multidisciplinary collaboration: widespread, but with still uneven integration of psychological support into care pathways.

Why it is important

It is clear from our survey that there is a need:

  • Structured, trauma-informed training for all professionals involved;
  • National guidelines to ensure uniformity and quality of care;
  • Stable integration of psychological support in all care settings;
  • Continuity of care pathways that accompany the family from pre-conception to postpartum.

Investing in these areas means reducing the risk of new trauma, improving the caregiving experience, and contributing to the long-term well-being of parents and children.

đź“„ Read the full article (Open Access): Management of Subsequent Pregnancy After Perinatal Death: Results from the UNSURENESS Study

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Validation of the RIMS-IT scale.

by Fondazione CiaoLapo
written by Fondazione CiaoLapo

Coping with pregnancy loss is an emotionally complex and often underestimated experience. Women who experience it may develop anxiety, depression, post-traumatic stress symptoms, and complicated grief. However, until now, there has been no specific instrument in Italy to accurately assess the psychological experience of this experience.

Our new study, a collaboration between the University of Milano-Bicocca, the CiaoLapo ETS Foundation and the PeaRL Laboratory of the University of Florence, has led to the Italian validation of the Revised Impact of Miscarriage Scale (RIMS-IT), an instrument that will enable clinicians and researchers to identify early women at risk of developing psychological complications after pregnancy loss. The study has just been published in BMC Pregnancy and Childbirth.

A specific tool for often invisible suffering

Many current instruments assess perinatal grief in a general sense, but not all women perceive pregnancy loss as traditional grief. Some experience a strong sense of guilt or isolation; others suffer in silence because of the lack of social recognition of their grief. The RIMS-IT allows these nuances to be analyzed through three key dimensions:

  1. Isolation and guilt: how much a woman feels alone in her grief and how much she blames herself for the loss.
  2. Child loss: the intensity of the sense of grief and emotional emptiness.
  3. Devastating event: the perception of loss as a profound and destabilizing trauma.

We validated the RIMS-IT on 543 Italian women who had experienced pregnancy loss in the past 36 months and confirmed its reliability and validity.

What did we find?

  • Sixty-one percent of women reported a significant psychological impact, with symptoms of stress and anxiety particularly high in women with repeat abortions.
  • Guilt and social isolation emerged as key factors of distress, confirming that many women feel misunderstood and deprived of support.
  • ⚠️ Current bereavement rating scales may not be sufficient to capture the specific psychological distress of women experiencing pregnancy loss.

An aid for clinicians and researchers

RIMS-IT represents a step forward for perinatal mental health, providing a new tool for gynecologists, midwives, psychologists and researchers:

âś… Early identification of women at risk of developing psychological complications.
âś… Personalize psychological support pathways, preventing suffering from remaining undetected.
âś… Improve research on maternal mental health by integrating more specific and detailed data.

Conclusions

The validation of the Revised Impact of Miscarriage Scale (RIMS-IT) in Italy is an important step in improving recognition and support for women facing pregnancy loss. Our study confirmed thereliability and psychometric validity of the instrument, even in Italian women, with high internal consistency(Cronbach’s alpha = 0.89) and a factorial structure reflecting that of the original version.

The RIMS-IT showed strong correlation with other scales assessing grief and post-traumatic stress, such as the Perinatal Grief Scale (PGS) and the National Stressful Events PTSD Short Scale (NSESSS), showing its specificity in measuring post-abortion psychological distress.

These results suggest that RIMS-IT can be a valuable tool for clinical and research, allowing early identification of women at risk and improving psychological care after pregnancy loss. Further studies may extend its applicability to other contexts, including the assessment of paternal experience, which has yet to be explored.

If you would like to learn more about our study, find the full article here:

Nespoli, A., Fumagalli, S., Mosconi, L., Bonaiuti, R., Vannacci, A., Ravaldi, C., Assessment of the psychometric properties of the Italian version of the revised impact of miscarriage scale (RIMS): a validity and reliability study. BMC Pregnancy Childbirth 25, 289 (2025). https://doi.org/10.1186/s12884-025-07422-5

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