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Irmscher L, Marx R, Linke M, Zimmermann A, Drössler S, Berth H. Anxiety, depression, somatization and psychological distress before and 2-6 years after a late termination of pregnancy due to fetal anomalies. BMC Womens Health 2024; 24:255. [PMID: 38658921 PMCID: PMC11040822 DOI: 10.1186/s12905-024-03082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND For many women, a late termination of pregnancy (TOP) can be an enormous psychological burden. Few studies have investigated the long-term psychological impact of late TOP. METHODS N = 90 women answered a questionnaire containing questions about anxiety, depression and somatization (Brief-Symptom Inventory, BSI-18) shortly before (T1) and 2-6 years after (T4) their late termination of pregnancy. RESULTS Prior to the late TOP, 57.8% of participants showed above-average levels of overall psychological distress (66.7% anxiety, 51.1% depression, 37.8% somatization). This number decreased significantly over time for all scales of the BSI-18. 2-6 years later, only 10.0% of women still reported above-average levels (17.8% anxiety, 11.1% depression, 10.0% somatization). CONCLUSIONS Our results support those of previous research showing that late TOP has a substantial psychological impact on those experiencing it in the short-term. In the long-term, most women return to normal levels of psychological distress, although some still show elevated levels. Limitations of the study include monocentric data collection, drop-out between T1 and T4, and the relatively wide range of two to six years after TOP. Further research should be conducted in order to identify factors that impact the psychological processing of the experience.
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Affiliation(s)
- Lisa Irmscher
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany.
| | - Romy Marx
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany
| | - Maike Linke
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany
| | - Anja Zimmermann
- Charité Universitätsmedizin Berlin, Referat für Studienangelegenheiten, 10115, Berlin, Germany
| | - Stephanie Drössler
- Freistaat Sachsen, Landesamt für Schule und Bildung, Beratungsstelle zur Begabtenförderung, 01445, Berlin, Germany
| | - Hendrik Berth
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany
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Alexopoulos J, Tmej A, Naderer A, Grussmann M, Tordy K, Stammler-Safar M, Feichtinger K, Gipperich A, Leithner K. Men don't cry: The supporting role as necessary for women's well-being after termination of pregnancy. Int J Gynaecol Obstet 2024; 164:1205-1211. [PMID: 37922219 DOI: 10.1002/ijgo.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES The present study investigated similarities and differences of grief between men and women as part of the parental couple 1 year after termination of pregnancy (TOP) following a diagnosis of fetal anomaly. METHODS We applied a method triangulation approach. We assessed several aspects of perinatal grief, depressive symptoms, posttraumatic stress, and anxiety as well as health-related quality of life. In addition, we conducted qualitative interviews with the men to explore the fathers' roles in the partnership during pregnancy, the time of the diagnosis, TOP, and afterwards. RESULTS Women showed a more elevated grief response compared with men. Qualitative data revealed that men in our sample were mainly concerned with their partners' well-being and concentrated on supporting their partners rather than on their own emotions. In addition, the supportive role of the male partner plays a central role in the well-being of women and the man's coping with the situation. CONCLUSION In clinical work, but also when developing new questionnaires, the specific role of the male partners needs to be considered more thoroughly. Particular attention should be paid to identify the men who find it difficult to assume the supporting role.
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Affiliation(s)
- Johanna Alexopoulos
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Anna Tmej
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andrea Naderer
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Magdalena Grussmann
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Karin Tordy
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Maria Stammler-Safar
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Karin Feichtinger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andrea Gipperich
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Katharina Leithner
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Slade L, Obst K, Deussen A, Dodd J. The tools used to assess psychological symptoms in women and their partners after termination of pregnancy for fetal anomaly: A scoping review. Eur J Obstet Gynecol Reprod Biol 2023; 288:44-48. [PMID: 37423121 DOI: 10.1016/j.ejogrb.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
Termination of pregnancy for fetal anomaly (TOPFA) represents a uniquely distressing and challenging situation for women and their partners. Having appropriate screening tools that best highlight the psychological symptoms experienced by women and their partners is important to be able to guide care. Many validated screening tools for pregnancy and psychological distress exist, with variation in the ease of application and the domains addressed in each. We undertook a scoping review of tools used to assess psychological symptoms in women and/or partners after TOPFA. Of 909 studies, 93 studies including 6248 women and 885 partners were included. Most of the included studies assessed symptoms within six months of TOPFA and highlighted high rates of distress, grief and trauma symptoms. There was broad variation in the tools used between studies and the timing of their implementation. Focusing the care of women and families who undergo TOPFA to validated, broadly available and easily applied screening tools that assess a range of psychological symptoms is key in being able to identify the potential interventions that may be of benefit.
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Affiliation(s)
- Laura Slade
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia.
| | - Kate Obst
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea Deussen
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Jodie Dodd
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia
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Armour S, Keedle H, Gilkison A, Dahlen HG. Midwifery care for late termination of pregnancy: Integrative review. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100889. [PMID: 37454584 DOI: 10.1016/j.srhc.2023.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Midwives provide reproductive healthcare to women, including during termination of pregnancy (TOP) after 12 weeks (late TOP). Their expertise, knowledge and woman-centred care approach sees them ideally placed for this role. However, the medical, social and emotional complexities of late TOP can cause midwives significant distress. An integrative review methodology was used to examine the research on midwifery care for late TOP and identify support strategies and interventions available to midwives in this role. Five databases and reference lists were searched for relevant studies published between 2000 and 2021. A total of 2545 records were identified and 24 research studies included. Synthesis of research findings resulted in three themes: Positive aspects, negative aspects and carers need care. Midwives reported a high level of job satisfaction when caring for women during late TOP. Learning new skills and overcoming challenges were positive aspects of their work. Yet, midwives felt unprepared to deal with challenging aspects of late TOP care such as the grief and the psychological burden of the role. Caring for the baby with dignity had both positive and negative aspects. Midwives relied predominantly on close colleagues for help and debriefing as they felt poorly supported by management, judged by co-workers and lacked appropriate support to reduce the emotional effects of late TOP care. Midwives need support, although current evidence has not identified the most appropriate and effective strategy to support them in this role.
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Affiliation(s)
- Susanne Armour
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia.
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
| | - Andrea Gilkison
- Auckland University of Technology, School of Clinical Sciences, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
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Li X, Peng H, Hu S, Xie J, Qin C. How does stigma influence depressive symptoms among women who underwent termination of pregnancy for foetal anomaly: A path analysis. J Clin Nurs 2023; 32:1410-1420. [PMID: 35583605 DOI: 10.1111/jocn.16372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/18/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES The purpose of this study was to explore the effect and paths of stigma on depressive symptoms in women who underwent termination of pregnancy for foetal anomaly (TOPFA). BACKGROUND Stigma may cause distress and depressive symptoms for women with TOPFA. However, few studies have examined the relationship between stigma and depression in women with TOPFA. DESIGN This study followed the STROBE checklist. A cross-sectional survey was conducted among 469 women with TOPFA. The path analysis used hierarchical multiple regression and structural equation model to examine the mediating role of social support and psychological flexibility on the relationship between stigma and depressive symptoms. RESULTS Hierarchical multiple regression analysis revealed the mediation effect of psychological flexibility between stigma and depressive symptoms. By contrast, social support did not present such effect. The structural equation model confirmed that stigma, directly and indirectly, affected depressive symptoms. DISCUSSION Many women with TOPFA have severe depressive symptoms and that stigma is an important influencing factor. Psychological flexibility plays an essential role in mitigating the effects of stigma on depressive symptoms. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should focus on measuring and intervening on stigma and psychological flexibility for alleviating the depressive symptoms of women with TOPFA. No Patient or Public Contribution.
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Affiliation(s)
- Xi Li
- Department of Health Management, Third XiangYa Hospital, Central South University, Changsha, China.,Jishou University School of Medical, Jishou, China
| | - Huiting Peng
- Department of Gynaecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Siqing Hu
- XiangYa Nursing School, Central South University, Changsha, China
| | - Jiaying Xie
- XiangYa Nursing School, Central South University, Changsha, China
| | - Chunxiang Qin
- Department of Health Management, Third XiangYa Hospital, Central South University, Changsha, China
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Assessing psychosocial costs: Ohio patients' experiences seeking abortion care. Contraception 2023; 117:45-49. [PMID: 36087646 DOI: 10.1016/j.contraception.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Existing research has not thoroughly characterized the psychosocial costs associated with seeking abortion care in restrictive states. Our study seeks to fill this gap by analyzing the accounts of Ohio abortion patients from 2018 to 2019. STUDY DESIGN Using inductive and deductive approaches, we analyzed semi-structured in-depth qualitative interviews with 41 Ohio residents who obtained abortion care from one of three clinics in Ohio or Pennsylvania. RESULTS Ohioans seeking abortion care often experienced fear of judgment, interpersonal strain, and stress as a result of efforts to overcome pre-Dobbs financial, geographic, and timing challenges. Those who needed financial assistance or traveled more than an hour generally reported greater exposure to psychosocial costs. CONCLUSIONS Participants in this study incurred a complex set of psychosocial costs. Psychosocial costs often resulted from, or were exacerbated by, the financial, geographic, and time-sensitive burdens that patients experienced seeking care. IMPLICATIONS The psychosocial costs incurred by patients seeking abortion care may be exacerbated in restrictive contexts, especially those who do not have access to insurance coverage for care. Psychosocial costs associated with care seeking are likely to increase as states implement more severe restrictions post-Dobbs. To fully understand abortion costs, researchers must examine costs comprehensively, including both financial and psychosocial costs.
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Li X, Peng H, Zeng L, Owusua T, Wang Y, Wang Y, Qin C. Stigma and its influencing factors among women with termination of pregnancy for fetal anomaly: A cross-sectional study. Midwifery 2023; 116:103553. [PMID: 36410260 DOI: 10.1016/j.midw.2022.103553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the level of stigma and identify its influencing factors among women with termination of pregnancy for fetal anomaly(TOPFA) in China. DESIGN This was a cross-sectional study design. SETTING AND PARTICIPANTS A total of 469 women with TOPFA were recruited from a tertiary care hospital in China using a convenience sampling method. MEASUREMENT AND FINDINGS Women with TOPFA participating in the study completed the Demographic Characteristics Questionnaire, Individual Level Abortion Stigma Scale(ILASS), Acceptance and Action Questionnaire- II scale(AQQ- II), Cognitive Fusion Questionnaire scale (CFQ), Multidimensional Perceived Social Support Scale(MPSS), Responses to Stress Questionnaire (RSQ). Women with TOPFA reported moderate levels of stigma(1.49±0.60). Multiple linear regression showed that correlates influencing their stigma included gestational age (β =0.103, P < 0.05), psychological flexibility (β =-0.319, P < 0.01), social support(β =-0.190, P < 0.01), and disengagement coping(β =0.148, P < 0.05). KEY CONCLUSION AND IMPLICATION FOR PRACTICE Gestational age and disengagement coping are positive predictors of stigma, but psychological flexibility and social support are negative predictors of stigma. Further attention should focus on developing targeted intervention strategies to improve protective and reduce harmful factors to confront the stigma-related challenges faced by women with TOPFA.
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Affiliation(s)
- Xi Li
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; Jishou University School of Medical, Jishou, China.
| | - Huiting Peng
- Xiangya School of Nursing, Central South University, Changsha, China; Department of Gynaecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Lihong Zeng
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Ying Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yaohan Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chunxiang Qin
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China.
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Di Chiara M, Laccetta G, Gangi S, De Santis B, Spiriti C, Attenni M, Bertolaso L, Boscarino G, De Nardo MC, Ciambra G, Parisi P, Terrin G. Risk factors and preventive strategies for post-traumatic stress disorder in neonatal intensive care unit. Front Psychol 2022; 13:1003566. [PMID: 36438350 PMCID: PMC9683535 DOI: 10.3389/fpsyg.2022.1003566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/20/2022] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Preterm birth and admission to the neonatal intensive care unit (NICU) could induce post-traumatic stress disorder (PTSD). PTSD is an important factor to focus on, as it is associated with parental mental health difficulties and with changes in caregiving quality such as increased intrusiveness, reduced sensitivity, and increased attachment insecurity for the child. AIMS We aimed to study the main risk factors, in the early life of newborns, and preventive measures for PTSD in parents of neonates hospitalized in the NICU. METHODS We included parents of preterm newborns, consecutively admitted to the NICU of the University La Sapienza of Rome. The presence of PTSD following preterm birth and NICU admission was assessed using the Clinician-administered PTSD scale (CAPS) at enrollment and at 28-30 days following NICU admission or the moment of discharge. We also evaluated the Family Environment Scale which measures the social environment of all types of families; the Parental Stressor Scale which measures parental anxiety and stress; the Spielberger State-Trait Anxiety Inventory consisting of two parts measuring the State (response to present situation) and Trait (pre-disposition to be anxious) anxieties separately, and the Beck Depression Inventory Second Edition assessing depressive symptoms. RESULTS We found, in a multivariate analysis, that the gestational age of newborns admitted to NICU significantly (β = 2.678; p = 0.040) influences the occurrence of PTSD. We found that the cases showed significantly (β = 2.443; p = 0.020) more pathological Parental Stressor Scale sights and sounds scores compared to controls. The early Kangaroo-Care (KC) significantly (β = -2.619; p = 0.015) reduces the occurrence of PTSD. CONCLUSION Post-traumatic stress disorder in parents of preterm newborns is a pathological condition that should be properly managed, in the very first days after birth. The NICU environment represents a main risk factor for PTSD, whereas KC has been demonstrated to have a protective role in the occurrence of PTSD.
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Affiliation(s)
- Maria Di Chiara
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gianluigi Laccetta
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Sara Gangi
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Benedetta De Santis
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Caterina Spiriti
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Martina Attenni
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Laura Bertolaso
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Boscarino
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara De Nardo
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gianluca Ciambra
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Levy S, Avitsur R. Gender Differences in the Development of Posttraumatic Stress Symptoms Following Pregnancy Loss: Social Support and Causal Attributes. PSYCHOLOGICAL STUDIES 2022. [DOI: 10.1007/s12646-022-00691-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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di Giacomo E, Pessina R, Placenti V, Pescatore F, Colmegna F, Clerici M. Therapeutic termination of pregnancy and major psychiatric outcomes in parents. Psychiatry Res 2022; 317:114779. [PMID: 36030698 DOI: 10.1016/j.psychres.2022.114779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Therapeutic termination of pregnancy (TToP) may have psychiatric outcomes like depression, anxiety and post-traumatic-stress disorder (PTSD). MATERIAL AND METHODS 45 couples had psychiatric evaluation before TToP and after one-year period. RESULTS TToP is linked to acute development of depressive symptoms that recover with time and professional support. Twelve percent of women developed PTSD (but 29.5% refused one-year evaluation due to mental distress at recalling TToP). Fathers showed no psychiatric outcomes. CONCLUSIONS Acute depressive symptoms after TToP improve with professional support but PTSD rate is concerning and stress importance of mental health implications and need for adequate related treatments.
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Affiliation(s)
- Ester di Giacomo
- School of Medicine and Surgery, University of Milano-Bicocca, Lombardy, Italy; Psychiatric Department, ASST Monza, Lombardy, Italy.
| | - Rodolfo Pessina
- Psychiatric Residency Training Program, University of Milano-Bicocca, Lombardy, Italy
| | - Valeria Placenti
- Psychiatric Residency Training Program, University of Genoa, Liguria, Italy
| | - Francesca Pescatore
- Psychiatric Residency Training Program, University of Milano-Bicocca, Lombardy, Italy
| | | | - Massimo Clerici
- School of Medicine and Surgery, University of Milano-Bicocca, Lombardy, Italy; Psychiatric Department, ASST Monza, Lombardy, Italy
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Oftedal A, Bekkhus M, Haugen GN, Czajkowski NO, Kaasen A. The impact of diagnosed fetal anomaly, diagnostic severity and prognostic ambiguity on parental depression and traumatic stress: a prospective longitudinal cohort study. Acta Obstet Gynecol Scand 2022; 101:1291-1299. [PMID: 36106375 PMCID: PMC9812208 DOI: 10.1111/aogs.14453] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/06/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The detection of a fetal anomaly during routine obstetric ultrasound is a potentially traumatic experience. The aim of this study is to examine longitudinally the impact of diagnosis of fetal anomaly on symptoms of depression and traumatic stress among mothers and fathers, and to examine how variations in psychological adjustment relate to diagnostic severity and prognostic ambiguity. MATERIAL AND METHODS In this prospective observational study conducted at a tertiary perinatal referral center, 81 mothers and 69 fathers with ultrasound findings of fetal anomaly completed the Edinburgh Postnatal Depression Scale (EPDS) and Impact of Events Scale (IES) at four time points in pregnancy (T1-T4) and 6 weeks after birth (T5). We compared this with depression and traumatic stress in a sample of non-affected parents (n = 110 mothers, 98 fathers). RESULTS Linear mixed effects models indicated that parents who received a diagnosis of fetal anomaly experienced higher levels of depression and traumatic stress over time, compared with non-affected parents. Depression: mean difference mothers = 4.46 ± 0.47, fathers = 2.80 ± 0.42. Traumatic stress: mean difference mothers = 20.04 ± 2.13, fathers = 12.66 ± 1.74. Parents with a more severe diagnosis experienced elevated symptoms compared with parents with a less severe diagnosis. Among mothers, prognostic ambiguity and changes in the anticipated diagnosis after birth were also associated with increased distress, regardless of whether the change was for the better or worse. CONCLUSIONS Diagnosis of fetal anomaly increases risk of depression and traumatic stress in expectant mothers and fathers, both acutely and over time.
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Affiliation(s)
- Aurora Oftedal
- Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Mona Bekkhus
- Department of PsychologyPromenta Research Center, University of OsloOsloNorway
| | - Guttorm Nils Haugen
- Division of Obstetrics and GynecologyOslo University HospitalOsloNorway,Institute of Clinical Medicine, University of OsloOsloNorway
| | - Nikolai Olavi Czajkowski
- Department of PsychologyPromenta Research Center, University of OsloOsloNorway,Norwegian Institute of Public HealthOsloNorway
| | - Anne Kaasen
- Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
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Borovich A, Handelzalts JE, Levy S, Rafenberg K, Borovich L, Dollinger S, Peled Y, Nassie DI, Krissi H. The effect of stillbirth and late termination of pregnancy on the emergence of post-traumatic symptoms among attending medical personnel. J OBSTET GYNAECOL 2022; 42:1841-1846. [PMID: 35468036 DOI: 10.1080/01443615.2022.2042796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this paper was to assess the impact and the post-traumatic potential of late termination of pregnancy (TOP) and stillbirth on medical staff and characterise personal attributes that modulate these possible outcomes. Fifty-one participants involved in the treatment of women undergoing late TOPs and stillbirths answered questionnaires including demographics, Neuroticism subscale of the Big Five Inventory (BFI), Life Orientation Test-Revised (LOT-R), Posttraumatic Diagnostic Scale (PDS), Brief Symptom Inventory (BSI-18) and questions regarding exposure to stillbirths and late TOPs. None of the participants met the full post-traumatic stress disorder (PTSD) criteria. A correlation with a marginal significance was found between the number of TOP's/stillbirths attended during the past year and traumatic symptoms. Neuroticism moderated the association between presence in TOP's/stillbirths and post-traumatic symptoms among those who attended this event over the past month. According to our results, medical personnel do not appear to develop long-term and lingering posttraumatic symptoms following attending TOP's/stillbirths. Impact StatementWhat is already known on this subject? There is a very little research on the ways in which medical personnel respond to Stillbirths, late miscarriages and terminations of pregnancy (TOP) of their patients and on the possible effect of their personality traits in this response.What do the results of this study add? According to our results, medical personnel do not appear to develop long-term and lingering posttraumatic symptoms following attending TOP's/stillbirths.What are the implications of these findings for clinical practice and/or further research? Further studies are warranted to better assess the impact of exposure to traumatic events in general and on the effect of late TOP and stillbirths in particular, on medical personnel and to identify interventions that may prevent posttraumatic symptoms among staff members when they happen.
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Affiliation(s)
- Adi Borovich
- Department of Obstetrics & Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan E Handelzalts
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.,Psychiatry Department, University of Michigan, Ann Arbor, MI, USA
| | - Sigal Levy
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Karin Rafenberg
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Liat Borovich
- Department of Obstetrics & Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Sarah Dollinger
- Department of Obstetrics & Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Peled
- Department of Obstetrics & Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel I Nassie
- Department of Obstetrics & Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Krissi
- Department of Obstetrics & Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kerns J, Cheeks M, Cassidy A, Pearlson G, Mengesha B. Abortion Stigma and Its Relationship with Grief, Post-traumatic Stress, and Mental Health-Related Quality of Life After Abortion for Fetal Anomalies. WOMEN'S HEALTH REPORTS 2022; 3:385-394. [PMID: 35415714 PMCID: PMC8994429 DOI: 10.1089/whr.2021.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/13/2022]
Abstract
Background: Materials and Methods: Results: Discussion: Implications for Practice and/or Policy:
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Affiliation(s)
- Jennifer Kerns
- Division of Zuckerberg San Francisco General, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Morgan Cheeks
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Arianna Cassidy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Geffan Pearlson
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Biftu Mengesha
- Division of Zuckerberg San Francisco General, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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The mental health impact of perinatal loss: A systematic review and meta-analysis. J Affect Disord 2022; 297:118-129. [PMID: 34678403 DOI: 10.1016/j.jad.2021.10.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/23/2023]
Abstract
Perinatal loss can pose a significant risk to maternal mental health. There is limited data on the strength of association between perinatal loss and subsequent common mental health disorders (CMHD) such as anxiety, depression and post-traumatic symptoms (PTS). A systematic review and meta-analysis identified studies with control groups, published between January 1995 and March 2020 reporting validated mental health outcomes following perinatal loss. We identified 29 studies from 17 countries, representing a perinatal loss sample (n = 31,072) and a control group of women not experiencing loss (n = 1,261,517). We compared the likelihood of increased CMHD in both groups. Random-effects modelling on suggested that compared to controls, perinatal loss was associated with increased risk of depressive (RR = 2.14, 95% CI = 1.73-2.66, p < 0.001, k = 22) and anxiety disorders (RR = 1.75, 95% CI = 1.27-2.42, p < 0.001, k = 9). Compared to controls, Perinatal loss was also associated with increased depression (SMD = 0.34, 95% CI = 0.20-0.48, p < 0.001, k = 12) and anxiety scores (SMD = 0.35, 95% CI = 0.12-0.58, p < 0.003, k = 10). There were no significant effects for post-traumatic stress (PTS) outcomes (k = 3). Our findings confirm that anxiety and depression levels following perinatal loss are significantly elevated compared to "no loss" controls (live-births, non pregnant from community, or difficult live births). Elevated depression and anxiety rates were also reported for those who experienced loss during later stages of pregnancy. Assessing mental health following loss is a maternal health priority.
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Zuelke AE, Luppa M, Löbner M, Pabst A, Schlapke C, Stein J, Riedel-Heller SG. Effectiveness and Feasibility of Internet-Based Interventions for Grief After Bereavement: Systematic Review and Meta-analysis. JMIR Ment Health 2021; 8:e29661. [PMID: 34889769 PMCID: PMC8701663 DOI: 10.2196/29661] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although grief and its symptoms constitute a normal reaction to experiences of loss, some of those affected still report elevated levels of distress after an extended period, often termed complicated grief. Beneficial treatment effects of face-to-face therapies, for example, grief counseling or cognitive behavioral therapy against complicated grief, have been reported. Evaluations of internet- and mobile-based interventions targeting symptoms of grief in bereaved individuals with regard to objective quality criteria are currently lacking. OBJECTIVE We aim to conduct a systematic review and meta-analysis on the effectiveness and feasibility of internet- and mobile-based interventions against symptoms of grief after bereavement. METHODS We conducted systematic literature searches of randomized controlled trials or feasibility studies published before January 9, 2020, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, in PubMed, PsycINFO, Web of Science Core Collection, and the Cochrane Library. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations system. We further assessed aspects of feasibility and rated quality of interventions using criteria suggested by an expert panel on mental health care (German Association for Psychiatry, Psychotherapy, and Psychosomatics). A random-effects meta-analysis was conducted to assess between-group effect sizes. RESULTS In total, 9 trials (N=1349) were included. Of these, 7 studies were analyzed meta-analytically. Significant effects were found for symptoms of grief (g=0.54, 95% CI 0.32-0.77), depression (g=0.44, 95% CI 0.20-0.68), and posttraumatic stress (g=0.82, 95% CI 0.63-1.01). Heterogeneity was moderate for grief and depression (I2=48.75% and 55.19%, respectively) and low for posttraumatic stress symptoms (I2=0%). The overall quality of evidence was graded low (grief and depression) to moderate (posttraumatic stress). User satisfaction with the interventions was high, as was the quality of the interventions assessed using objective quality criteria. CONCLUSIONS Internet- or mobile-based interventions might constitute an effective treatment approach against symptoms of grief in bereaved adults. However, the small sample sizes and limited number of studies included in the review warrant further investigation. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42012002100; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131428.
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Affiliation(s)
- Andrea E Zuelke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Christine Schlapke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
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di Giacomo E, Pessina R, Santorelli M, Rucco D, Placenti V, Aliberti F, Colmegna F, Clerici M. Therapeutic termination of pregnancy and women’s mental health: Determinants and consequences. World J Psychiatry 2021; 11:937-953. [PMID: 34888166 PMCID: PMC8613757 DOI: 10.5498/wjp.v11.i11.937] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/27/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
The therapeutic termination of pregnancy (TToP) is an induced abortion following a diagnosis of medical necessity. TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability. This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother. Socio-cultural and economic determinants could influence the desire for children and family planning in couples, as well as the use of effective contraception and the choice to perform an induced abortion. Also, pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP. Furthermore, the TToP is a reproductive event with an important traumatic burden, but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples. The aim of this review is to evaluate what demographic, reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women. Also, we will examine both positive and negative consequences of this procedure on women’s mental health, underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.
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Affiliation(s)
- Ester di Giacomo
- School of Medicine and Surgery, University Milan Bicocca, Monza 20900, Lombardy, Italy
- Department of Psychiatric, ASST Monza, Monza 20900, Lombardy, Italy
| | - Rodolfo Pessina
- Psychiatric Residency Training Program, University Milan Bicocca, Monza 20900, Lombardy, Italy
| | - Mario Santorelli
- Psychiatric Residency Training Program, University Milan Bicocca, Monza 20900, Lombardy, Italy
| | - Daniele Rucco
- PhD Program in Psychology, Linguistics and Cognitive Neuroscience, University Milan Bicocca, Milano 20126, Lombardy, Italy
| | - Valeria Placenti
- Psychiatric Residency Training Program, University of Genova, Genova 16126, Liguria, Italy
| | - Francesca Aliberti
- Psychiatric Residency Training Program, University Milan Bicocca, Monza 20900, Lombardy, Italy
| | | | - Massimo Clerici
- School of Medicine and Surgery, University Milan Bicocca, Monza 20900, Lombardy, Italy
- Department of Psychiatric, ASST Monza, Monza 20900, Lombardy, Italy
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Güçlü O, Şenormanci G, Tüten A, Gök K, Şenormanci Ö. Perinatal Grief and Related Factors After Termination of Pregnancy for Fetal Anomaly: One-Year Follow-up Study. ACTA ACUST UNITED AC 2021; 58:221-227. [PMID: 34526846 PMCID: PMC8419734 DOI: 10.29399/npa.25110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022]
Abstract
Introduction: Many people grieve in a resilient manner, often having a sense of equilibrium restored within six months. The most devastating type of loss is usually considered to be the death of the child. For such a loss, bereavement may take a period of distressing years with signs and symptoms that are related to grief. There have been different phases identified in the grieving process, and this process encompasses various difficulties with different levels of psychological effects. Women with perinatal losses can suffer long periods of grief. The purpose of this study was to monitor the grief in women who had undergone a termination of pregnancy due to fetal anomaly. Methods: Forty-six women who applied to the Gynaecology Clinic of Istanbul University Cerrahpaşa Faculty of Medicine and who decided to terminate their pregnancy due to fetal anomaly were included in the study. The Perinatal Grief Scale (PGS), the Impact of Event Scale-Revised (IES-R), Beck Anxiety Inventory (BAI), the Edinburgh Postnatal Depression Scale (EPDS), the Multidimensional Relationship Questionnaire (MRQ) and the Adult Attachment Scale (AAS) were administered to the participants six weeks after termination. Participants’ grief signs were re-evaluated with the PGS at the sixth and 12th months. Results: There was no relationship between severity of grief symptoms and socio-demographic and clinical characteristics of the patients. The perinatal grief symptoms can decrease gradually from termination of pregnancy to six months and can persist for a period of six months up to a year. There was positive correlation between the scores of PGS and BAI, IES-R hyper-arousal. The mean score of PGS changed significantly from sixth week to sixth month and from sixth week to 12th months. IES-R hyper-arousal and MRQ relational satisfaction were found to be the predictors for PGS total score at the first year. Conclusion: The diagnosis of fetal anomaly and especially the termination of pregnancy itself may be traumatic and disruptive. In women with perinatal loss, grief may become persistent after the first six months. It would be helpful to examine how the women resolve this experience. Especially the anxiety and the hyper-arousal signs following the termination should not be ignored. Perinatal grief is a unique bereavement experience; specific interventions should be performed for detecting and treating severe perinatal grief.
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Affiliation(s)
- Oya Güçlü
- Department of Psychiatry, University of Health Sciences Bakırköy Training and Research Hospital, İstanbul, Turkey
| | - Güliz Şenormanci
- Department of Psychiatry, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Abdullah Tüten
- Department of Obstetrics and Gynecology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Koray Gök
- Department of Obstetrics and Gynecology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Ömer Şenormanci
- Department of Psychiatry, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Li Y, Tang S, Lu J, Huang C, Peng H, Xie J, Borjigen A, Liu M, Qin C. Prevalence and Factors Associated With Depressive Symptomatology Among Women Before Termination of Pregnancy for Fetal Anomaly. J Psychosoc Nurs Ment Health Serv 2020; 58:43-50. [PMID: 32976606 DOI: 10.3928/02793695-20200921-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to investigate the prevalence of depressive symptomatology before termination of pregnancy due to fetal anomaly and to analyze associated risk factors. A cross-sectional study was performed in the obstetric departments of six hospitals in Hunan, China. Depressive symptomatology was measured before termination of pregnancy using the Edinburgh Postpartum Depression Scale. t test, analysis of variance, and binary logistic regression tests were used in the data analysis of depressive symptomatology and factors. A total of 65.6% (n = 177) of participants were identified with depressive symptomatology before termination. Risk factors were receipt of spousal support, self-efficacy, religious belief, history of adverse pregnancy outcomes, and sleep disturbance. Protective factors were engagement with health care providers, social support, and higher monthly family income. Nurses should be aware of these factors early on to prevent the occurrence of depressive symptomatology, thereby improving maternal mental health. [Journal of Psychosocial Nursing and Mental Health Services, 58(12), 43-50.].
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19
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Kamranpour B, Noroozi M, Bahrami M. Psychological experiences of women with pregnancy termination due to fetal anomalies: a qualitative study from the perspective of women, their spouses, and healthcare providers in Iran. Reprod Health 2020; 17:109. [PMID: 32646449 PMCID: PMC7346605 DOI: 10.1186/s12978-020-00959-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pregnancy termination due to fetal anomalies has many psychological consequences for women. Providing appropriate and desirable care to this group of women and their families plays an important role in the process of coping with this crisis. The aim of the present study was to explore the psychological experiences of women with pregnancy termination due to fetal anomalies. Methods This was a qualitative content analysis study. 40 participants were selected through purposeful sampling with maximum variation and data were collected through in-depth individual interviews, field notes, and analyzed using the conventional qualitative content analysis method simultaneously. Results After analyzing the interview transcripts, the psychological experiences of women with pregnancy termination due to fetal anomalies were classified into two main categories: “emotional reactions coinciding with the diagnosis of fetal anomalies” (consisting of two sub-categories of “disbelief and denial of fetal anomalies” and “feelings of sadness and anger”) and “ psychological problems following pregnancy termination” (consisting of two sub-categories of “ feeling helpless, fearful, anxious, and depressed” and “feeling conscience-stricken, and guilty”). Conclusion According to findings of the present study, exploring and highlighting the experiences of women with pregnancy termination due to fetal anomalies in the psychological dimension can provide a deeper understanding of the needs of these women for providing optimal care at different times and ultimately promote their psychological health.
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Affiliation(s)
- Bahareh Kamranpour
- Department of Midwifery, College of Nursing and Midwifery, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Masoud Bahrami
- Department of Adult Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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20
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Gonçalves JL, Fuertes M, Alves MJ, Antunes S, Almeida AR, Casimiro R, Santos M. Maternal pre and perinatal experiences with their full-term, preterm and very preterm newborns. BMC Pregnancy Childbirth 2020; 20:276. [PMID: 32375667 PMCID: PMC7204281 DOI: 10.1186/s12884-020-02934-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/13/2020] [Indexed: 01/07/2023] Open
Abstract
Background Mothers’ reports about pregnancy, maternity and their experiences during the perinatal period have been associated with infants’ later quality of attachment and development. Yet, there has been little research with mothers of very preterm newborns. This study aimed to explore mothers’ experiences related to pregnancy, premature birth, relationship with the newborn, and future perspectives, and to compare them in the context of distinct infants’ at-birth-risk conditions. Methods A semi-structured interview was conducted with women after birth, within the first 72 h of the newborn’s life. A total of 150 women participated and were divided in three groups: (1) 50 mothers of full-term newborns (Gestational Age (GA) ≥ 37 weeks; FT), (2) 50 mothers of preterm newborns (GA 32–36 weeks; PT) and (3) 50 mothers of very preterm newborns (GA < 32 weeks; VPT). Results Mothers of full-term infants responded more often that their children were calm and that they did not expect difficulties in taking care of and providing for the baby. Mothers of preterm newborns although having planned and accepted well the pregnancy (with no mixed or ambivalent feelings about it) and while being optimistic about their competence to take care of the baby, mentioned feeling frightened because of the unexpected occurrence of a premature birth and its associated risks. Mothers of very preterm newborns reported more negative and distressful feelings while showing more difficulties in anticipating the experience of caring for their babies. Conclusion The results indicate that Health Care Systems and Neonatal Care Policy should provide differentiated psychological support and responses to mothers, babies and families, taking into account the newborns’ GA and neonatal risk factors.
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Affiliation(s)
- Joana L Gonçalves
- Center for Psychology at University of Porto (CPUP), Rua Alfredo Allen, 4200-135, Porto, Portugal.
| | - Marina Fuertes
- Center for Psychology at University of Porto (CPUP), Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Maria João Alves
- Center for Psychology at University of Porto (CPUP), Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Sandra Antunes
- School of Health Technology, Polytechnic Institute of Lisbon, Lisbon, Portugal
| | - Ana Rita Almeida
- Lisbon School of Education/CIED, Polytechnic Institute of Lisbon, Lisbon, Portugal
| | - Rute Casimiro
- Lisbon School of Education/CIED, Polytechnic Institute of Lisbon, Lisbon, Portugal
| | - Margarida Santos
- School of Health Technology, Polytechnic Institute of Lisbon, Lisbon, Portugal.,Faculty of Psychology and Education Sciences, University of Lisbon, Lisbon, Portugal
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21
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Sun S, Yang M, Zhang J, Zhou X, Jia G, Yu X. Family support for pregnant women with foetal abnormality requiring pregnancy termination in China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1020-1029. [PMID: 31919920 DOI: 10.1111/hsc.12935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
Family support is an important protective factor for pregnant women with a foetal abnormality and can prevent adverse psychological outcomes in this population. This study aimed to explore the importance and influencing factors of family support for pregnant women with foetal abnormalities requiring pregnancy termination and then determine the correlation between family support and women's post-traumatic stress symptoms. A mixed methods study was conducted from March 2016 to September 2017. In all, 214 participants were surveyed using self-reported questionnaires including the demographic, family and obstetric information questionnaire, the Family Adaptation Partnership Growth Affection and Resolve Index and the Impact of Event Scale-Revised to collect quantitative data. Semi-structured in-depth interviews with 28 participants were conducted to collect qualitative data. Of the pregnant women with foetal abnormalities, 35% had obstacles in family function such that family support was low. The Impact of Event Scale-Revised score was negatively associated with total score on the Family Adaptation Partnership Growth Affection and Resolve Index as well as the score for each item on this index. In terms of family support, the demographic, family and obstetric variables hierarchically entered into the regression models significantly explained 20.0%, 26.5% and 2.6% of variation, respectively. In addition, three key themes were identified based on qualitative analyses: intensified instrumental support, inadequate emotional support and insufficient informational support. The findings showed that family support plays a protective role in preventing post-traumatic stress symptoms following termination of pregnancy. At present, family support still needs to be improved, especially in emotional support and informational support. The factors influencing family support may be important to consider for improving family support.
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Affiliation(s)
- Shiwen Sun
- Department of nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengye Yang
- Department of Nursing, Suzhou Municipal Hospital, Suzhou, China
| | - Jieqiong Zhang
- Department of nursing, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Xiaoli Zhou
- Department of Nursing, Suzhou Municipal Hospital, Suzhou, China
| | - Ge Jia
- Department of Nursing, Medical college of Shihezi University. No, Shihezi, China
| | - Xiaoyan Yu
- Department of nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, China
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22
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Evolution of third-trimester pregnancy terminations in France. Eur J Obstet Gynecol Reprod Biol 2020; 248:123-127. [PMID: 32203822 DOI: 10.1016/j.ejogrb.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study changes in the reasons for third-trimester termination of pregnancy (TOP) for fetal anomalies over a 20-year period in France. STUDY DESIGN We compared a consecutive series of third-trimester TOPs from a single centre in 2005-2014 to those performed by Dommergues et al. in a similar centre in 1986-1994, using the same criteria. MAIN OUTCOME MEASURES The process leading to late TOP, using the same categories in both studies. RESULTS In the present series, 205 of 1409 TOPs were performed in the third trimester, vs. 305/956 in the historical series. There were 33 (16.1 %) diagnoses missed at the screening before the third trimester, 55 (26.8 %) cases in which the anomaly was impossible to diagnose until the third trimester, 86 (42 %) cases in which fetal prognosis could not be established until the third trimester despite earlier diagnosis, 31 (15.1 %) TOPs postponed to allow more time for the women/couples to contemplate, versus respectively 113 (37 %), 55 (18 %), 122 (40 %), and 15 (5%) in the historical series. CONCLUSION There was a significant drop in the rate of anomalies missed earlier. The increase in late TOP due to couples requiring additional time for contemplation might result from changes in counselling processes.
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Abstract
BACKGROUND Fetal death causes women to experience negative feelings after the loss. These lived experiences influence the future pregnancies and maternal health of women negatively. PURPOSE The aim of this study was to investigate the experiences of women whose pregnancies were terminated because of medical indications. METHODS A "design for definitive status study" type of qualitative research design was used. Ten women who were hospitalized between April and July 2017 at the Akdeniz University Clinic of Obstetrics and Gynecology and had subsequently experienced pregnancy loss during their hospitalization were enrolled as participants. Thematic analysis was used to analyze the data. RESULTS The pregnancy loss experiences of participants were investigated under the five main themes of (a) lived experiences before the termination of pregnancy, (b) lived experiences after pregnancy termination, (c) willingness to see the baby after termination, (d) posttermination care requirements, and (e) physical condition of hospital rooms during hospitalization. The participants expressed feelings of hope, fear, and worry over being unsuccessful before fetal death and feelings of loneliness, disappointment, blame, and avoidance after fetal death. CONCLUSIONS/IMPLICATIONS FOR PRACTICE In the aftermath of fetal death, health professionals should use insightful and empathic communication skills to help mothers cope with their loss. In addition, some of the participants wanted to see their babies, and some did not. Thus, individualized care is very important for women who experience pregnancy loss.
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Tung I, Beardslee J, Pardini D, Chung T, Keenan K, Hipwell AE. Adolescent childbirth, miscarriage, and abortion: associations with changes in alcohol, marijuana, and cigarette use. J Child Psychol Psychiatry 2020; 61:104-111. [PMID: 31424096 PMCID: PMC6906255 DOI: 10.1111/jcpp.13112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adolescent girls who become pregnant demonstrate greater risk for substance use than same-aged peers. However, it remains unclear how risk relates to normative changes in adolescence. Few studies have examined adolescent substance use changes before, during, and after pregnancy and considered how pregnancy outcomes (childbirth, miscarriage, abortion) differentially influence substance use changes. The present study examined associations between different adolescent pregnancy outcomes and within-person changes in substance use from prepregnancy to postpregnancy. METHODS Participants included 2,450 girls (52% Black) oversampled from low-income urban neighborhoods in Pittsburgh, PA. Participants self-reported pregnancy outcomes and substance use frequency (alcohol, cigarette, marijuana) annually from ages 11-20. Fixed effects regressions focused on first births, first miscarriages, and first abortions occurring from ages 12-19 to test the associations between pregnancy outcomes and within-individual changes in substance use from prepregnancy to postpregnancy. By design, models controlled for all potential time-stable confounds, and models included age and subsequent pregnancies as time-varying covariates. RESULTS Consistent with prior studies, girls who became pregnant (20%) reported greater early risk for substance use problems than never-pregnant adolescents, including earlier age of onset and more regular marijuana and cigarette use. Childbirth predicted a 26%-51% within-individual reduction in alcohol, marijuana, and cigarette use that remained significantly lower than prepregnancy levels after childbirth. Alcohol and marijuana use decreased (32%-47%) after miscarriage. Abortion was not associated with long-term changes in substance use; however, marijuana and cigarette use gradually increased (44%-46%) in the years leading up to the year of and after abortion, respectively, before returning to prepregnancy levels. CONCLUSIONS Findings highlight important differences in adolescent substance use patterns based on pregnancy outcome. For pregnant adolescents with heightened pre-existing risk for substance use, pregnancy may be a window of opportunity for substance use screening and behavioral intervention.
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Affiliation(s)
- Irene Tung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Jordan Beardslee
- School of Criminology and Criminal Justice, Arizona State University, Phoenix, AZ
| | - Dustin Pardini
- School of Criminology and Criminal Justice, Arizona State University, Phoenix, AZ
| | - Tammy Chung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
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Andrushchenko NV, Muhamedrahimov RJ, Kryukov EY, Iova AS, Arintsina IA, Anikina VO, Poteshkina OV, Solodunova MY, Chernego DI. [Mothers' emotional states and characteristics of early interaction with their prematurely born babies]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:148-153. [PMID: 31317904 DOI: 10.17116/jnevro2019119051148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Advanced technologies of neonatal reanimation and intensive care have led to the increase in the number of children with the extremely low and low birth weight. These children constitute a risk group often having severe development complications and disabilities. This article provides a review of the existing research literature on emotional states of mothers of prematurely born infants' and characteristics of their early interaction. The data on the influence of the mother's emotional state on her interaction with her prematurely born infant and its impact on the child's long-term development are presented. The authors present directions of studying development of prematurely born infants, which are not fully reflected in the literature, regarding infants with structural intracranial changes (intraventricular hemorrhages) and associated hydrocephalus and posthemorrhagic hydrocephaly. New targets of practical work have been developed to improve the family-centered interdisciplinary support for children at infancy and early age.
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Affiliation(s)
- N V Andrushchenko
- Saint Petersburg State University, St. Petersburg, Russia; Mechnikov North-Western State Medical University, St.-Petersburg, Russia
| | | | - E Yu Kryukov
- Mechnikov North-Western State Medical University, St.-Petersburg, Russia
| | - A S Iova
- Mechnikov North-Western State Medical University, St.-Petersburg, Russia
| | - I A Arintsina
- Saint Petersburg State University, St. Petersburg, Russia
| | - V O Anikina
- Saint Petersburg State University, St. Petersburg, Russia
| | - O V Poteshkina
- Mechnikov North-Western State Medical University, St.-Petersburg, Russia
| | | | - D I Chernego
- Saint Petersburg State University, St. Petersburg, Russia
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Akdag Topal C, Terzioglu F. Assessment of depression, anxiety, and social support in the context of therapeutic abortion. Perspect Psychiatr Care 2019; 55:618-623. [PMID: 31004351 DOI: 10.1111/ppc.12380] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/25/2019] [Accepted: 03/30/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The purpose of this study is to determine the levels of anxiety, depression, social support, and nursing care needed by women undergoing therapeutic abortion. DESIGNS AND METHODS Sixty women were administered a sociodemographic form, the Hospital Anxiety Depression Scale and the Multidimensional Perceived Social Support Scale. RESULTS More than half of the women experienced anxiety (61.7%). Anxiety scores were high (10.8 ± 3.7), and most of the women had depression (85.0%). Social support from family and friends of the women decreased the women's anxiety and depression levels significantly; social support from their partners also decreased the women's anxiety levels (P < 0.05). PRACTICE IMPLICATIONS Support from family and friends after therapeutic abortion is a fundamental affective variable on anxiety scores.
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Affiliation(s)
- Cansu Akdag Topal
- Department of Obstetrics and Gynecologic Nursing, Faculty of Nursing, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Fusun Terzioglu
- Department of Nursing, Faculty of Health Sciences, Atilim University, Golbasi, Ankara, Turkey
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Kessels SJM, Carter D, Ellery B, Newton S, Merlin TL. Prenatal genetic testing for cystic fibrosis: a systematic review of clinical effectiveness and an ethics review. Genet Med 2019; 22:258-267. [PMID: 31467445 DOI: 10.1038/s41436-019-0641-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/13/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE We aimed to assess the clinical value of prenatal testing for cystic fibrosis (CF) and whether ethical considerations would affect endpoint selection. METHODS To determine effectiveness, we conducted a systematic literature review whose protocol outlined search strategies across eight databases, study inclusion criteria, and prespecified literature screening, data extraction, and synthesis processes. We conducted a scoping search on ethical considerations. RESULTS The genetic test showed good diagnostic performance. A change in clinical management was observed: termination of pregnancy (TOP) occurred in most cases where two pathogenic variants were identified in a fetus of carrier parents (158/167; 94.6%). The TOP rate was lower in pregnancies where CF was diagnosed after fetal echogenic bowel detection (~65%). TOP and caring for a child with CF were both associated with poor short-term parental psychological outcomes. Ethical analyses indicated that informed decisions should have been the main endpoint, rather than CF-affected births prevented. CONCLUSION CF testing leads to fewer CF-affected births. It is difficult to assess whether this means the test is valuable, since patients may not value TOP primarily in terms of maternal or fetal health outcomes, psychological or otherwise. The value of testing should arguably be measured in terms of improving patient autonomy rather than health.
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Affiliation(s)
- Sharon J M Kessels
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Drew Carter
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia.
| | - Benjamin Ellery
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Skye Newton
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Tracy L Merlin
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
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Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis. J Clin Psychiatry 2019; 80:18r12527. [PMID: 31347796 PMCID: PMC6839961 DOI: 10.4088/jcp.18r12527] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/08/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To estimate the prevalence of anxiety disorders in pregnant and postpartum women and identify predictors accounting for variability across estimates. DATA SOURCES An electronic search of PsycINFO and PubMed was conducted from inception until July 2016, without date or language restrictions, and supplemented by articles referenced in the obtained sources. A Boolean search phrase utilized a combination of keywords related to pregnancy, postpartum, prevalence, and specific anxiety disorders. STUDY SELECTION Articles reporting the prevalence of 1 or more of 8 common anxiety disorders in pregnant or postpartum women were included. A total of 2,613 records were retrieved, with 26 studies ultimately included. DATA EXTRACTION Anxiety disorder prevalence and potential predictor variables (eg, parity) were extracted from each study. A Bayesian multivariate modeling approach estimated the prevalence and between-study heterogeneity of each disorder and the prevalence of having 1 or more anxiety disorder. RESULTS Individual disorder prevalence estimates ranged from 1.1% for posttraumatic stress disorder to 4.8% for specific phobia, with the prevalence of having at least 1 or more anxiety disorder estimated to be 20.7% (95% highest density interval [16.7% to 25.4%]). Substantial between-study heterogeneity was observed, suggesting that "true" prevalence varies broadly across samples. There was evidence of a small (3.1%) tendency for pregnant women to be more susceptible to anxiety disorders than postpartum women. CONCLUSIONS Peripartum anxiety disorders are more prevalent than previously thought, with 1 in 5 women in a typical sample meeting diagnostic criteria for at least 1 disorder. These findings highlight the need for anxiety screening, education, and referral in obstetrics and gynecology settings.
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Affiliation(s)
- Emily J. Fawcett
- Student Wellness and Counselling Centre, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Nichole Fairbrother
- Department of Psychiatry / Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - Megan L. Cox
- Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - Ian R. White
- MRC Clinical Trials Unit, University College London, London, UK
| | - Jonathan M. Fawcett
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
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Dekkers FHW, Go ATJI, Stapersma L, Eggink AJ, Utens EMWJ. Termination of pregnancy for fetal anomalies: Parents' preferences for psychosocial care. Prenat Diagn 2019; 39:575-587. [PMID: 30997678 PMCID: PMC6767557 DOI: 10.1002/pd.5464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 11/08/2022]
Abstract
Objective To investigate, from the perspective of women and partners, at what stage of a termination of pregnancy (TOP) for fetal anomalies psychosocial care (PSC) is most meaningful, what topics should be discussed, and who should provide PSC. Method A cross‐sectional retrospective cohort study was conducted with a consecutive series of 76 women and 36 partners, who completed a semi‐structured online questionnaire. Results Overall, women expressed a greater need for PSC than their partners. Parents expressed a preference for receiving support from a maternal‐fetal medicine specialist to help them understand the severity and consequences of the anomalies found and to counsel them in their decision regarding termination. Parents showed a preference for support from mental healthcare providers to help with their emotional responses. Forty‐one percent of the women visited a psychosocial professional outside of the hospital after the TOP, indicating a clear need for a well‐organised aftercare. Conclusion Different disciplines should work together in a complementary way during the diagnosis, decision making, TOP, and aftercare stages. Parents' need for PSC should be discussed at the beginning of the process. During aftercare, attention should be paid to grief counselling, acknowledgement of the lost baby's existence, and possible future pregnancies. What's already known about this topic?
Pregnancy termination for fetal anomalies has multiple psychological consequences for parents. Parents are mostly unaware of the need for psychosocial care during and after pregnancy termination. What does this study add?
Knowledge about which stage parents consider to be most meaningful for psychosocial care, the topics that should be discussed, and who should provide psychosocial care. Awareness that different disciplines should collaborate during and after the pregnancy termination.
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Affiliation(s)
- Frederike H W Dekkers
- Department of Child and Adolescent Psychiatry/Psychology, Unit of Psychosocial Care, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Attie T J I Go
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Luuk Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Unit of Psychosocial Care, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alex J Eggink
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Unit of Psychosocial Care, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry, the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
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Kamranpour B, Noroozi M, Bahrami M. Supportive needs of women who have experienced pregnancy termination due to fetal abnormalities: a qualitative study from the perspective of women, men and healthcare providers in Iran. BMC Public Health 2019; 19:507. [PMID: 31053091 PMCID: PMC6500064 DOI: 10.1186/s12889-019-6851-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 04/17/2019] [Indexed: 12/03/2022] Open
Abstract
Background Extensive application of screening tests for early diagnosis of fetal abnormalities would justify support for women who are facing pregnancy termination due to fetal abnormalities. Considering the lack of available information regarding supportive sources for these people, the present study was conducted to determine the supportive needs of women who have experienced pregnancy termination due to fetal abnormalities. Methods The present research was a qualitative study. The participants were selected using a purposeful sampling method with maximum variation. Data were collected through in-depth personal interviews and taking of field notes and were analyzed simultaneously using conventional content analysis. Results The main categories that appeared in the present study included “support from the husband” with sub-categories of “mental support and necessary accompaniments”, “participating in planning for future pregnancy” and “financial support to pay the costs of diagnosis and follow-up”, “support from the family and friends” with sub-categories of “helping in taking care of other children”, “help in performing daily activities” and “empathy, companionship and necessary support to maintain mental peace” and finally “support from peers” with sub-categories of “communicating with the peers and receiving information from them” and “creating a sense of confidence and hopefulness”. Conclusions Results of the present study, by determining and highlighting the supportive needs of women who have experienced pregnancy termination due to fetal abnormalities, could be an appropriate basis for providing effective strategies to improve constant participation of the husbands, family members and the peers along with other professional care. Electronic supplementary material The online version of this article (10.1186/s12889-019-6851-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bahareh Kamranpour
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Midwifery, College of Nursing and Midwifery, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Massoud Bahrami
- Department of Adult Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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31
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Lafarge C, Rosman S, Ville I. Pregnancy termination for fetal abnormality: Ambivalence at the heart of women's experience. WOMENS STUDIES INTERNATIONAL FORUM 2019. [DOI: 10.1016/j.wsif.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Li J, Tang S, Liu M, Liu W, Cheng C, Li Y, Sun M, Qin C. The relationship between salivary cortisol and perinatal depression in women undergoing termination of pregnancy for fetal anomaly: A prospective cohort study. Midwifery 2019; 75:103-109. [PMID: 31071585 DOI: 10.1016/j.midw.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/17/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenal axis plays a crucial role in the neurobiological pathways for depression. The aim of this study was to determine the relationship between salivary cortisol and depression in women before and after termination of pregnancy due to fetal anomaly. STUDY DESIGN A prospective cohort study was conducted. One-way ANOVA and linear correlation were conducted to analyse the relationship between salivary cortisol and depression before and after termination of pregnancy. RESULTS No significant difference in morning and evening cortisol levels between women underwent TOP for fetal anomaly without depression and those with depression, but the women underwent TOP for fetal anomaly had significantly higher levels of morning and evening cortisol than women with healthy pregnancy. Cortisol awakening response was lower in women underwent termination of pregnancy, than in women with normal pregnancy; lower in women underwent termination of pregnancy with depression than in those women without depression. Cortisol awakening response also had a negative correlation with depression, and the correlation coefficients for cortisol awakening response and depression after TOP (R = 0.461) were higher than the correlation coefficients for cortisol awakening response and depression before TOP(R = 0.238). CONCLUSIONS Our results were not only useful to support the hypothesis that hypothalamic-pituitary-adrenal axis functioning would turn hypoactive, with depression progressing to increase in severity, but also helpful with insights into the predictive effects of cortisol awakening response in depression after TOP. We suggest that further research should be conducted on the relationship between salivary cortisol and depression before and after TOP for fetal anomaly.
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Affiliation(s)
- Jinxiu Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Minhui Liu
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
| | - Wei Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Chunxia Cheng
- Obstetrics Department of the Third Xiangya Hospital, Changsha, Hunan, China
| | - Ying Li
- Pediatric Department of the Third Xiangya Hospital, Changsha, Hunan, China
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Chunxiang Qin
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China; Obstetrics Department of the Third Xiangya Hospital, Changsha, Hunan, China.
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Guy B. I Poems on Abortion: Women’s Experiences With Terminating Their Pregnancies for Medical Reasons. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/23293691.2018.1523115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Anencephaly; the maternal experience of continuing with the pregnancy. Incompatible with life but not with love. Midwifery 2018; 71:12-18. [PMID: 30640134 DOI: 10.1016/j.midw.2018.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 12/04/2018] [Accepted: 12/22/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE As advances in prenatal diagnosis increasingly enable detection of life-limiting conditions, end-of-life care may start before birth. Termination of these pregnancies may have been default management, but in the Republic of Ireland, where termination is not a legal option, skilled experience in caring for mothers who continue their pregnancies has developed. This study examines the lived experience of four such mothers. METHOD A qualitative study was designed using interpretive phenomenological analysis, which examined the maternal experience of continuing pregnancy with a prenatal diagnosis of anencephaly. Four mothers participated in semi-structured interviews on their experience of pregnancy and delivery of a baby with anencephaly. RESULTS A profoundly emotional journey represented an adaptive grieving process, which culminated in rich experiences of transformative growth for all the parents. The parents' relationship with their caregivers facilitated this process and the development of a meaningful parenting relationship with their babies. This positive finding coexists alongside a parallel experience of ongoing deep sense of loss and sadness. CONCLUSION Perinatal palliative care for those with a prenatal lethal diagnosis is a positive life experience for some mothers. The role of relationship with healthcare professionals is vital to the process and consideration must be given to a comprehensive multi-disciplinary team approach.
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Fawcett JM, Fairbrother N, Fawcett EJ, White IR. A Bayesian multivariate approach to estimating the prevalence of a superordinate category of disorders. Int J Methods Psychiatr Res 2018; 27:e1742. [PMID: 30216590 PMCID: PMC6383646 DOI: 10.1002/mpr.1742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/17/2018] [Accepted: 07/03/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Epidemiological research plays an important role in public health, facilitated by the meta-analytic aggregation of epidemiological trials into a single, more powerful estimate. This form of aggregation is complicated when estimating the prevalence of a superordinate category of disorders (e.g., "any anxiety disorder," "any cardiac disorder") because epidemiological studies rarely include all of the disorders selected to define the superordinate category. In this paper, we suggest that estimating the prevalence of a superordinate category based on studies with differing operationalization of that category (in the form of different disorders measured) is both common and ill-advised. Our objective is to provide a better approach. METHODS We propose a multivariate method using individual disorder prevalences to produce a fully Bayesian estimate of the probability of having one or more of those disorders. We validate this approach using a recent case study and parameter recovery simulations. RESULTS Our approach produced less biased and more reliable estimates than other common approaches, which were at times highly biased. CONCLUSION Although our approach entails additional effort (e.g., contacting authors for individual participant data), the improved accuracy of the prevalence estimates obtained is significant and therefore recommended.
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Affiliation(s)
- Jonathan M Fawcett
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Nichole Fairbrother
- Department of Psychiatry and the Island Medical Program, University of British Columbia, Vancouver, BC, Canada
| | - Emily J Fawcett
- Student Wellness and Counselling Centre, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Ian R White
- MRC Clinical Trials Unit, University College London, London, UK
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Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med 2018; 6:2050312118807624. [PMID: 30397472 PMCID: PMC6207970 DOI: 10.1177/2050312118807624] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
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van Gool JD, Hirche H, Lax H, De Schaepdrijver L. Folic acid and primary prevention of neural tube defects: A review. Reprod Toxicol 2018; 80:73-84. [DOI: 10.1016/j.reprotox.2018.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 12/31/2022]
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Wang J, Chen L, Zhou C, Wang L, Xie H, Xiao Y, Zhu H, Hu T, Zhang Z, Zhu Q, Liu Z, Liu S, Wang H, Xu M, Ren Z, Yu F, Cram DS, Liu H. Prospective chromosome analysis of 3429 amniocentesis samples in China using copy number variation sequencing. Am J Obstet Gynecol 2018; 219:287.e1-287.e18. [PMID: 29852155 DOI: 10.1016/j.ajog.2018.05.030] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/25/2018] [Accepted: 05/22/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Next-generation sequencing is emerging as a viable alternative to chromosome microarray analysis for the diagnosis of chromosome disease syndromes. One next-generation sequencing methodology, copy number variation sequencing, has been shown to deliver high reliability, accuracy, and reproducibility for detection of fetal copy number variations in prenatal samples. However, its clinical utility as a first-tier diagnostic method has yet to be demonstrated in a large cohort of pregnant women referred for fetal chromosome testing. OBJECTIVE We sought to evaluate copy number variation sequencing as a first-tier diagnostic method for detection of fetal chromosome anomalies in a general population of pregnant women with high-risk prenatal indications. STUDY DESIGN This was a prospective analysis of 3429 pregnant women referred for amniocentesis and fetal chromosome testing for different risk indications, including advanced maternal age, high-risk maternal serum screening, and positivity for an ultrasound soft marker. Amniocentesis was performed by standard procedures. Amniocyte DNA was analyzed by copy number variation sequencing with a chromosome resolution of 0.1 Mb. Fetal chromosome anomalies including whole chromosome aneuploidy and segmental imbalances were independently confirmed by gold standard cytogenetic and molecular methods and their pathogenicity determined following guidelines of the American College of Medical Genetics for sequence variants. RESULTS Clear interpretable copy number variation sequencing results were obtained for all 3429 amniocentesis samples. Copy number variation sequencing identified 3293 samples (96%) with a normal molecular karyotype and 136 samples (4%) with an altered molecular karyotype. A total of 146 fetal chromosome anomalies were detected, comprising 46 whole chromosome aneuploidies (pathogenic), 29 submicroscopic microdeletions/microduplications with known or suspected associations with chromosome disease syndromes (pathogenic), 22 other microdeletions/microduplications (likely pathogenic), and 49 variants of uncertain significance. Overall, the cumulative frequency of pathogenic/likely pathogenic and variants of uncertain significance chromosome anomalies in the patient cohort was 2.83% and 1.43%, respectively. In the 3 high-risk advanced maternal age, high-risk maternal serum screening, and ultrasound soft marker groups, the most common whole chromosome aneuploidy detected was trisomy 21, followed by sex chromosome aneuploidies, trisomy 18, and trisomy 13. Across all clinical indications, there was a similar incidence of submicroscopic copy number variations, with approximately equal proportions of pathogenic/likely pathogenic and variants of uncertain significance copy number variations. If karyotyping had been used as an alternate cytogenetics detection method, copy number variation sequencing would have returned a 1% higher yield of pathogenic or likely pathogenic copy number variations. CONCLUSION In a large prospective clinical study, copy number variation sequencing delivered high reliability and accuracy for identifying clinically significant fetal anomalies in prenatal samples. Based on key performance criteria, copy number variation sequencing appears to be a well-suited methodology for first-tier diagnosis of pregnant women in the general population at risk of having a suspected fetal chromosome abnormality.
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Affiliation(s)
- Jing Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Lin Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Cong Zhou
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Li Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Hanbing Xie
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yuanyuan Xiao
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Hongmei Zhu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ting Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zhu Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Qian Zhu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zhiying Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Shanlin Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - He Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Mengnan Xu
- Berry Genomics Corporation, Beijing, China
| | - Zhilin Ren
- Berry Genomics Corporation, Beijing, China
| | - Fuli Yu
- Berry Genomics Corporation, Beijing, China; Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | | | - Hongqian Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
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Hanschmidt F, Treml J, Klingner J, Stepan H, Kersting A. Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression. Arch Womens Ment Health 2018; 21:391-399. [PMID: 29288285 DOI: 10.1007/s00737-017-0807-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/18/2017] [Indexed: 11/24/2022]
Abstract
Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women's psychological reactions. This study examined the influence of perceived and internalized stigma on women's long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women.
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Affiliation(s)
- Franz Hanschmidt
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Julia Treml
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Johanna Klingner
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
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Reardon DC. The Embrace of the Proabortion Turnaway Study: Wishful Thinking? or Willful Deceptions? LINACRE QUARTERLY 2018; 85:204-212. [PMID: 30275603 DOI: 10.1177/0024363918782156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The abortion advocacy group Advancing New Standards in Reproductive Health (ANSIRH) has published over twenty papers based on a case series of women taking part in their Turnaway Study. Following the lead of ANSIRH news releases, major media outlets have described these results as proof that (a) most women who have abortions are glad they did, (b) there is no evidence of negative mental health effects following abortion, and (c) the only women really suffering are those who are being denied late-term abortions due to legal restrictions based on gestational age. Buried in ANSIRH's papers are the facts that over 68 percent of the women they sought to interview refused, their own evidence confirms that the remnant who did participate were atypical, there are no known benefits from abortion, their methods are misleadingly described, and their results are selectively reported. Summary: Widely publicized claims regarding the benefits of abortion for women have been discredited. The Turnaway Study, conducted by abortion advocates at thirty abortion clinics, reportedly proves that 95 percent of women have no regrets about their abortions and that abortion causes no mental health problems. But a new exposé reveals that the authors have misled the public, using an unrepresentative, highly biased sample and misleading questions. In fact, over two-thirds of the women approached at the abortion clinics refused to be interviewed, and half of those who agreed dropped out. Refusers and dropouts are known to have more postabortion problems.
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41
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Abortion after diagnosis of fetal anomaly: Psychometric properties of a German version of the individual level abortion stigma scale. PLoS One 2018; 13:e0197986. [PMID: 29894474 PMCID: PMC5997354 DOI: 10.1371/journal.pone.0197986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnosis of fetal anomaly is a significant life event and social stigma can negatively impact on the well-being of women opting for an abortion. This study investigated the psychometric properties of a measure of stigma among women who had had an abortion after diagnosis of fetal anomaly in a German setting. METHODS The Individual Level Abortion Stigma (ILAS) scale was translated into German. Psychometric properties of the ILAS scale were examined among 130 women with a history of an abortion after diagnosis of fetal anomaly. Individual and situational factors associated with stigma in the context of an abortion after diagnosis of fetal anomaly were explored. RESULTS Factor analysis suggested a four-dimensional structure of the German version of the Individual Level Abortion Stigma scale (Cronbach's α, .83-.91), corresponding to the subscales of the original scale. Test-retest reliability was acceptable for the worries about judgment subscale, the self-judgment subscale, and the community condemnation subscale, but less convincing for the isolation subscale. Associations between the subscales and measures of depression, self-esteem and secrecy were found in directions consistent with theory. Women who did not perceive their fetus to have a low survival chance and women whose fetus was at higher gestational age reported higher levels of stigma, whereas higher perceived partner support was associated with lower levels of stigma. LIMITATION Generalizability of study results was limited, as participants were recruited from one clinic in Germany and the study had a response rate of 46.5%. CONCLUSIONS The ILAS subscales are largely reliable and valid measures to assess stigma among women who have had an abortion after diagnosis of fetal anomaly. Suggestions for improving the assessment of stigma experienced in this population are outlined. The scales can be useful in research aiming at investigating psychological outcomes of abortion after diagnosis of fetal anomaly and improving care structures.
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42
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Effect of counseling quality on anxiety, grief, and coping after second-trimester abortion for pregnancy complications. Contraception 2018; 97:520-523. [DOI: 10.1016/j.contraception.2018.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/13/2018] [Accepted: 02/15/2018] [Indexed: 02/05/2023]
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Boyd RC, Scharko AM, Cole JCM, Patterson CA, Benton TD, Power TJ. Training Pediatric Psychologists for Perinatal Behavioral Health Services in a Pediatric Hospital. J Clin Psychol Med Settings 2018; 23:99-111. [PMID: 26531132 DOI: 10.1007/s10880-015-9439-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although pediatric hospitals specialize in providing care to children and adolescents, at The Children's Hospital of Philadelphia (CHOP), our team has been providing behavioral health services for two unique parent populations-parents with a child in the Newborn Infant Intensive Care Unit and pregnant women carrying fetuses with specific birth defects and receiving prenatal care in the Center for Fetal Diagnosis and Treatment. A new training program was developed to expand the scope of pediatric psychologists' practice to include perinatal behavioral health services, specifically for these two unique parent populations served at CHOP. The program includes direct service provision for adult mental health concerns, as well as education and support to help families cope with the existing medical conditions. This article describes the training program and its implementation as a model of training for other pediatric hospitals. The roles of psychologists embedded in these units and hospital privileges are discussed.
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Affiliation(s)
- Rhonda C Boyd
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Alexander M Scharko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joanna C M Cole
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chavis A Patterson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tami D Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Power
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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44
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Lafarge C, Mitchell K, Breeze ACG, Fox P. Pregnancy termination for fetal abnormality: are health professionals' perceptions of women's coping congruent with women's accounts? BMC Pregnancy Childbirth 2017; 17:60. [PMID: 28178933 PMCID: PMC5299639 DOI: 10.1186/s12884-017-1238-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/31/2017] [Indexed: 01/08/2023] Open
Abstract
Background Pregnancy termination for fetal abnormality (TFA) may have profound psychological consequences for those involved. Evidence suggests that women’s experience of care influences their psychological adjustment to TFA and that they greatly value compassionate healthcare. Caring for women in these circumstances presents challenges for health professionals, which may relate to their understanding of women’s experience. This qualitative study examined health professionals’ perceptions of women’s coping with TFA and assessed to what extent these perceptions are congruent with women’s accounts. Methods Fifteen semi-structured interviews were carried out with health professionals in three hospitals in England. Data were analysed using thematic analysis and compared with women’s accounts of their own coping processes to identify similarities and differences. Results Health professionals’ perceptions of women’s coping processes were congruent with women’s accounts in identifying the roles of support, acceptance, problem-solving, avoidance, another pregnancy and meaning attribution as key coping strategies. Health professionals regarded coping with TFA as a unique grieving process and were cognisant of women’s idiosyncrasies in coping. They also considered their role as information providers as essential in helping women cope with TFA. The findings also indicate that health professionals lacked insight into women’s long-term coping processes and the potential for positive growth following TFA, which is consistent with a lack of aftercare following TFA reported by women. Conclusions Health professionals’ perceptions of women’s coping with TFA closely matched women’s accounts, suggesting a high level of understanding. However, the lack of insight into women’s long-term coping processes has important clinical implications, as research suggests that coping with TFA is a long-term process and that the provision of aftercare is beneficial to women. Together, these findings call for further research into the most appropriate ways to support women post-TFA, with a view to developing a psychological intervention to better support women in the future.
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Affiliation(s)
- Caroline Lafarge
- School of Human and Social Sciences, University of West London, Paragon, Boston Manor Road, Brentford, TW8 9GA, UK.
| | - Kathryn Mitchell
- The Office of the Vice-Chancellor, University of Derby, Kedleston Road, Derby, DE22 1GB, UK
| | - Andrew C G Breeze
- Fetal Medicine Unit, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK
| | - Pauline Fox
- School of Human and Social Sciences, University of West London, Paragon, Boston Manor Road, Brentford, TW8 9GA, UK
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Lafarge C, Mitchell K, Fox P. Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief. ANXIETY STRESS AND COPING 2017; 30:536-550. [PMID: 28079405 DOI: 10.1080/10615806.2016.1278433] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Caroline Lafarge
- School of Human & Social Sciences, University of West London, Brentford, UK
| | | | - Pauline Fox
- School of Human & Social Sciences, University of West London, Brentford, UK
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46
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Lawson AK, Zweifel JE, Klock SC. Blurring the line between life and death: a review of the psychological and ethical concerns related to posthumous-assisted reproduction. EUR J CONTRACEP REPR 2016; 21:339-46. [PMID: 27388465 DOI: 10.1080/13625187.2016.1203892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Posthumous-assisted reproduction (PAR), though viewed unfavourably by some, is desirable to many individuals whose partners die prior to the completion of family building. PAR is technically feasible for males and females both pre- and post-mortem and these procedures have previously been completed on numerous occasions. However, such treatment is associated with three primary ethical concerns: autonomy; beneficence; and justice for the living, the deceased, and the soon-to-be conceived. Further, there are many psychological risks of PAR which may affect all involved parties. As such, early psychological counselling of patients and surviving family members is warranted.
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Affiliation(s)
- Angela K Lawson
- a Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology , Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Julianne E Zweifel
- b Reproductive Endocrinology and Infertility Clinic, Department of Obstetrics and Gynecology , University of Wisconsin-Madison , Madison , WI , USA
| | - Susan C Klock
- a Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology , Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
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47
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Shlomi Polachek I, Dulitzky M, Margolis-Dorfman L, Simchen MJ. A simple model for prediction postpartum PTSD in high-risk pregnancies. Arch Womens Ment Health 2016; 19:483-90. [PMID: 26399873 DOI: 10.1007/s00737-015-0582-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/14/2015] [Indexed: 11/28/2022]
Abstract
This study aimed to examine the prevalence and possible antepartum risk factors of complete and partial post-traumatic stress disorder (PTSD) among women with complicated pregnancies and to define a predictive model for postpartum PTSD in this population. Women attending the high-risk pregnancy outpatient clinics at Sheba Medical Center completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire regarding demographic variables, history of psychological and psychiatric treatment, previous trauma, previous childbirth, current pregnancy medical and emotional complications, fears from childbirth, and expected pain. One month after delivery, women were requested to repeat the EPDS and complete the Post-traumatic Stress Diagnostic Scale (PDS) via telephone interview. The prevalence rates of postpartum PTSD (9.9 %) and partial PTSD (11.9 %) were relatively high. PTSD and partial PTSD were associated with sadness or anxiety during past pregnancy or childbirth, previous very difficult birth experiences, preference for cesarean section in future childbirth, emotional crises during pregnancy, increased fear of childbirth, higher expected intensity of pain, and depression during pregnancy. We created a prediction model for postpartum PTSD which shows a linear growth in the probability for developing postpartum PTSD when summing these seven antenatal risk factors. Postpartum PTSD is extremely prevalent after complicated pregnancies. A simple questionnaire may aid in identifying at-risk women before childbirth. This presents a potential for preventing or minimizing postpartum PTSD in this population.
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Affiliation(s)
- Inbal Shlomi Polachek
- Beer Yaakov Mental Health Center, Beer Yaakov, Israel. .,Reproductive Life Stages Program, Women's Mental Health Program, Women's College Hospital, Toronto, Canada.
| | | | | | - Michal J Simchen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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48
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Helle N, Barkmann C, Ehrhardt S, von der Wense A, Nestoriuc Y, Bindt C. Postpartum anxiety and adjustment disorders in parents of infants with very low birth weight: Cross-sectional results from a controlled multicentre cohort study. J Affect Disord 2016; 194:128-34. [PMID: 26820762 DOI: 10.1016/j.jad.2016.01.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/06/2016] [Accepted: 01/10/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Both preterm delivery and survival rates of very low birth weight (VLBW: <1500 g) infants are increasing. To date, the focus on studies about postpartum mental health after preterm birth has been on depression and on women. There is a paucity of research regarding prevalence, risks, and predictors of postpartum anxiety in parents after VLBW birth. METHODS Parents with VLBW infants and parents with term infants were recruited into the longitudinal HaFEn-study at the three largest centers of perinatal care in Hamburg, Germany. State anxiety was assessed with the State-Trait-Anxiety Inventory and anxiety and adjustment disorders with a clinical interview one month postpartum. Psychiatric lifetime diagnoses, social support, trait anxiety, stress during birth, socioeconomic status, risks during pregnancy, and mode of delivery were also evaluated. To examine predictors of postpartum state anxiety in both parents simultaneously a multiple random coefficient model was used. RESULTS 230 mothers and 173 fathers were included. The risk for minor/major anxiety symptoms and adjustment disorders was higher in parents with VLBW infants compared to the term group. The risk for anxiety disorders was not higher in parents with VLBW infants. The most important predictors for postpartum state anxiety were high trait anxiety, the birth of a VLBW infant, high stress during birth, and low social support. LIMITATIONS Data reported here are cross-sectional. Thus, temporal relationships cannot be established. CONCLUSIONS Our results emphasize the importance of early screening for postpartum anxiety in both parents with VLBW infants.
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Affiliation(s)
- Nadine Helle
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany.
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Axel von der Wense
- Department of Neonatology and Paediatric Critical Care, Neonatal Intensive Care Unit, Altona Children's Hospital, Hamburg, Germany
| | - Yvonne Nestoriuc
- Institute of Psychology, Clinical Psychology and Psychotherapy, Hamburg University, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
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Fleming V, Iljuschin I, Pehlke-Milde J, Maurer F, Parpan F. Dying at life׳s beginning: Experiences of parents and health professionals in Switzerland when an ‘in utero ’ diagnosis incompatible with life is made. Midwifery 2016; 34:23-29. [DOI: 10.1016/j.midw.2016.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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50
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Abstract
This article is about selective abortion. It concentrates on the existential, moral and social conditions that arise when pregnant women, using prenatal diagnosis (PND), are told that there is something seriously wrong with the foetuses that they are carrying. This is characterised as a micro state of emergency, where both normal cognitive categories and normative orders are dissolved. The analyses are anchored in the womens' own presentations and understandings of the processes and dilemmas related to the abortion decisions, and our most important empirical materials are interviews with women who have experienced them. Our main ambition is to show the relation between some important dimensions of the situation in which the abortion decision has to be made, and the special kind of authority on behalf of the women that presents itself. Of equal importance is the vulnerability of the pregnant women, resulting in a co-production of the women as both Sovereigns and Homo Sacer in the decision situation. We also analyse some of the experienced relations between the women and the foetuses, and how the women constitute themselves as moral subjects, with a particular emphasis on the motifs of sacrifice and self-sacrifice. It is a central argument in the article that we have to understand the specificity of the decision situation, without reducing it either to other phases (before or after) of the total processes of PND and selective abortion, or to general discourses of disability or normality. The specificity of the situation in which the abortion decision is made is a pivotal point in society's regulation (in a broad sense) of the field and in the constitution of the regime of selective abortion.
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