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Flink-Bochacki R, McLeod C, Lipe H, Rapkin RB, Rubin SL, Heuser CC. Is it an abortion: Classification of pregnancy-ending interventions after 24 weeks in the presence of lethal fetal anomalies. Contraception 2024; 137:110492. [PMID: 38763276 DOI: 10.1016/j.contraception.2024.110492] [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: 01/23/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES To determine how obstetrician-gynecologists categorize pregnancy-ending interventions in the setting of lethal fetal anomalies. STUDY DESIGN We conducted a sequential explanatory mixed-methods study of U.S. obstetrician-gynecologists from May to July 2021. We distributed a cross-sectional online survey via email and social media and completed qualitative telephone interviews with a nested group of participants. We assessed institutional classification as induced abortion versus indicated delivery for six scenarios of ending a pregnancy with lethal anomalies after 24 weeks, comparing classification using McNemar chi-square tests with Benjamini-Hochberg correction for multiple comparisons with a false discovery rate of 0.05. We performed the thematic analysis of qualitative data and then performed a mixed-methods analysis. RESULTS We included 205 respondents; most were female (84.4%), had provided abortion care (80.2%), and were general OB/GYNs (59.3%), with broad representation across pre-Dobbs state and institutional abortion policies. Twenty-one qualitative participants had similar characteristics to the whole sample. All scenarios were classified as induced abortion by the majority of respondents, ranging from 53.2% for 32-week induction for anencephaly, to 82.9% for feticidal injection with 24-week induction for anencephaly. Mixed-methods analysis revealed the relevance of gestational age (later interventions less likely to be considered induced abortion) and procedure method and setting (dilation and evacuation, feticidal injection, and freestanding facility all increasing classification as induced abortion). CONCLUSIONS There is wide variation in the classification of pregnancy-ending interventions for lethal fetal anomalies, even among trained obstetrician-gynecologists. Method, timing, and location of ending a nonviable pregnancy influence classification, though the perinatal outcome is unchanged. IMPLICATIONS The classification of pregnancy-ending interventions for lethal fetal anomalies after 24 weeks as indicated delivery versus induced abortion is reflective of sociopolitical regulatory factors as opposed to medical science. The regulatory requirement for classification negatively impacts access to care, especially in environments where induced abortion is legally restricted.
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Affiliation(s)
- Rachel Flink-Bochacki
- Albany Med Health System, Department of Obstetrics and Gynecology, Albany, NY, United States.
| | - Corinne McLeod
- Albany Med Health System, Department of Obstetrics and Gynecology, Albany, NY, United States
| | - Hannah Lipe
- Albany Medical College, Albany, NY, United States
| | - Rachel B Rapkin
- Wellington Regional Hospital, Department of Obstetrics and Gynecology, Te Whatu Ora, Wellington, New Zealand
| | | | - Cara C Heuser
- University of Utah, Department of Obstetrics and Gynecology, Salt Lake City, UT, United States
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Pecoriello J, Lilly AG, Jalili D, Mendoza C, Quinn GP, Penfield CA. Decision-making for congenital anomalies diagnosed during pregnancy: a narrative review. J Assist Reprod Genet 2024; 41:1143-1151. [PMID: 38630201 PMCID: PMC11143132 DOI: 10.1007/s10815-024-03112-x] [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: 11/28/2023] [Accepted: 04/02/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE The purpose of this narrative review was to assess the limited literature on fetal anomalies diagnosed in the second trimester of pregnancy and parental decision-making and identify sources of information deemed as facilitators and barriers to medical decisions. METHODS This was a literature review of source material and information about fetal anomalies diagnosed in the second trimester of pregnancy, decision-making, decision tools or aids, and sources of information for anomalies. The search string used explored related peer-reviewed publications and systematic reviews between 2007 and 2024. We also reviewed references from publications meeting inclusion criteria. The search was conducted between June 2022 and February 2024. Exclusion criteria included conference abstracts, non-peer reviewed literature, and articles not available in English language. A total of 77 publications were identified by searching multiple databases using a predefined search string. The search encompassed full text articles from 2007 to 2024 and 11 full-text publications were ultimately included in the review. A list of 45 co-occurring keywords was generated from the included texts, with each keyword having a minimum of two co-occurrences. RESULTS Key themes identified included (1) the role of the clinician and need for development of professional knowledge and empathy surrounding discussion of fetal anomalies with patients; (2) information gathering, with individuals reporting use of multiple strategies to obtain information; while the majority found information satisfying, they preferred more details on diagnosis, long-term outcomes of the fetus/child and management of the pregnancy or termination process; and (3) decision-making, the path and process of how individuals made decisions about the pregnancy including quality of life, future fertility, and seeking other people's experiences. CONCLUSION Many factors contribute to an individual's decision-making after a diagnosis of a fetal anomalies diagnosed in the second trimester of pregnancy, ranging from personal beliefs and goals to shared experiences of others and access to care. Understanding how sources of information may be deemed both as facilitators and barriers to different individuals during the decision-making process is important for healthcare providers in order to understand how to most effectively support patients. There is a dearth of information on training healthcare professionals to provide support to patients facing these decisions.
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Affiliation(s)
- Jillian Pecoriello
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 1stAvenue, New York, NY, 10016, USA
| | | | - Dona Jalili
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 1stAvenue, New York, NY, 10016, USA
| | | | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 1stAvenue, New York, NY, 10016, USA.
| | - Christina A Penfield
- Division of Maternal Fetal Medicine, New York University Grossman School of Medicine, New York, NY, USA
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3
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Rankin HA, Voegtline K, Olson S, Sufrin C. Termination counseling among US perinatal genetic counselors in the setting of second trimester fetal anomalies. J Genet Couns 2024. [PMID: 38425099 DOI: 10.1002/jgc4.1888] [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: 07/21/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 03/02/2024]
Abstract
Many pregnant people learn of fetal anomalies in the second trimester and subsequently present to prenatal genetic counselors (PGCs) for counseling, including but not limited to a nuanced discussion about whether to continue or terminate pregnancy. In those who choose to terminate, the decision between dilation and evacuation (D&E) or induction is often one of patient preference and as such, is heavily influenced by the quality of counseling received. PGCs are expertly trained to provide values-based counseling, yet little is known about their termination counseling practices, referral practice patterns, and perceived responsibilities in caring for this group of pregnant people. To gain this knowledge, we surveyed a national sample of PGCs in early 2022 and received 70 completed responses. The survey contained open- and closed-ended questions. Data were analyzed using descriptive statistics, and free response data were analyzed using inductive content analysis. Eighty percent (n = 56) of respondents reported that <50% of their patients had previously received termination options counseling. Most strikingly, 15% of respondents provided termination counseling that was beyond their self-identified comfort level. Scenario-based questions assessed respondents' counseling practice patterns in seven real-world situations, presented in order of decreasing severity for the fetus. Respondents were 50% less likely to provide termination options counseling to patients between the most lethal to the least lethal proposed fetal anomaly. The scenario-based analysis revealed two distinct termination counseling approaches: (1) all options counseling with an explicit discussion of options to continue or terminate and (2) discretionary options counseling focused on identifying patient preferences to guide counseling and not explicitly stating all available options. This study highlights the need to ensure PGCs feel well-trained to discuss the general features of second trimester pregnancy termination and, if unable to do so, to practice in systems with timely referral to providers well-versed in the counseling about all methods of termination.
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Affiliation(s)
- Holly A Rankin
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kristin Voegtline
- Biostatistics, Epidemiology and Data Management Core, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sarah Olson
- Biostatistics, Epidemiology and Data Management Core, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
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Roncoroni J, Whitaker S, Magdamo B, Hendrix T, Zaręba K, Yohannes R. Perceptions of Patient-Centered Care and Their Association With Patient Satisfaction in Abortions for Medical Reasons. Womens Health Issues 2023:S1049-3867(23)00069-5. [PMID: 37230927 DOI: 10.1016/j.whi.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/10/2023] [Accepted: 03/03/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Abortions for medical reasons, which happen in the event of fetal abnormalities or maternal life endangerment, are highly politicized and understudied given their prevalence. Our objective was to understand the health care experiences of U.S. individuals who had an abortion of a wanted pregnancy for medical reasons in the second or third trimester. METHODS Participants were recruited on Facebook and completed surveys with their demographic information, their perception of their health provider's cultural sensitivity, their patient satisfaction, and their satisfaction with their decision to proceed with an abortion for medical reasons. RESULTS Participants were 132 women who were mostly between the ages of 31 and 40 (72.7%), highly educated (84.1% had at least a 4-year college degree), and non-Hispanic White (85.6%). There was no statistically significant difference in patients' rated highest average item score on their providers' Competence or Sensitivity; however, average item scores of providers' Competence and Sensitivity were both higher than Respect scores. Linear regression results show that experiencing patient-centered care significantly predicted patient satisfaction (β = .73, t(131) = 12.03, p < .001) and decision satisfaction (β = .37, t(131) = 4.63, p < .001). CONCLUSION Our findings underscore the importance of training providers to deliver patient-centered care that empowers patients to adapt to challenging situations, such as the diagnosis of medical concerns during pregnancy. Providers understanding and supporting the complex process of an abortion for medical reasons can ameliorate the emotional impact of this procedure.
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Affiliation(s)
- Julia Roncoroni
- Department of Counseling Psychology, University of Denver, Denver, Colorado.
| | - Salina Whitaker
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| | - Brigid Magdamo
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| | - Tayler Hendrix
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| | - Kornelia Zaręba
- Obstetrics & Gynecology Department, College of Medicine & Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Rebekah Yohannes
- Department of Counseling Psychology, University of Denver, Denver, Colorado
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Termination of pregnancy for fetal malformation: A traumatic event? A qualitative analysis of women's perception. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2023; 69:36-55. [PMID: 36927315 DOI: 10.13109/zptm.2023.69.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Objective: To investigate women's experience of termination of pregnancy (TOP) for severe fetal malformation.We focus on women's individual perception of psychological counselling on decision making, experiencing the birth process, seeing and holding the baby as well as emotional processing. Methods: An explorative study was conducted with 42 women (the age range was between 21 and 45 years [mean 36.17; SD±6.66]) on average twelve months after TOP using semi-structured qualitative interviews. All women received psychological counselling before, during and after the time of TOP (mean 5.2; range 2-11), at the initial counselling session all partners were present. Data were analysed by means of qualitative content analysis by Mayring; the main research question focused on women's perception of psychological counselling on experiencing TOP and coping with this incisive life event. Results: After receiving psychological counselling most of the women felt sufficiently prepared to make a decision, to experience the birth process and to bid farewell to their child. Seeing and holding the baby were perceived as helpful for emotional processing. At the time of the interview, despite the emotional distress,most women reported having positivememories and felt they had coped with the loss. Conclusions: Long-term psychological care from the time of diagnosis through TOP and follow up impacts positively on experiencing TOP, saying farewell to the child and integrating the loss into life. Further studies to detect women at risk for prolonged mourning-reactions are needed.
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Jia L, Li W, Liu Y, Wang L. Psychologic Sequelae in Early Pregnancy Complications. Int J Womens Health 2023; 15:51-57. [PMID: 36643713 PMCID: PMC9838123 DOI: 10.2147/ijwh.s382677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Early pregnancy complications, including miscarriage, ectopic pregnancies, and hyperemesis gravidarum, are common discomforts accounting for about 15% to 20% of all pregnancies. A proportion of women with early pregnancy complications will experience short- and long-term psychologic sequelae in the aftermath of pregnancy complications, including anxiety, depression, and post-traumatic stress disorder (PTSD) which are the most commonly reported psychologic reactions. This review will focus on the course and impact of these psychologic sequelae in early pregnancy complications, and the noninvasive interventions to improve mental health are also briefly discussed.
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Affiliation(s)
- Lili Jia
- Department of Gynaecology and Obstetrics, Binhai County People’s Hospital, Yancheng City, People’s Republic of China
| | - Wenfei Li
- Department of Gynaecology and Obstetrics, Binhai County People’s Hospital, Yancheng City, People’s Republic of China
| | - Yue Liu
- Department of Gynaecology and Obstetrics, Binhai County People’s Hospital, Yancheng City, People’s Republic of China
| | - Longqin Wang
- Department of Emergency, Binhai County People’s Hospital, Yancheng City, People’s Republic of China,Correspondence: Longqin Wang, Department of Emergency, Binhai County People’s Hospital, 248 Fudong Middle Road, Yancheng City, 224599, People’s Republic of China, Email
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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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8
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Pershad J, Mugerwa KY, Filippi V, Mehrtash H, Adu-Bonsaffoh K, Bello FA, Compaoré R, Gadama L, Govule P, Qureshi Z, Tunçalp Ӧ, Calvert C. Prevalence and determinants of self-reported anxiety and stress among women with abortion-related complications admitted to health facilities in Eastern and Southern Africa: A cross-sectional survey. Int J Gynaecol Obstet 2022; 156 Suppl 1:53-62. [PMID: 35014698 DOI: 10.1002/ijgo.14042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the prevalence of women who were admitted to health facilities with abortion-related complications who reported feeling anxious/stressed during their stay, and to identify sociodemographic, facility, and abortion-related characteristics associated with self-reported experience of anxiety/stress. METHODS We used data from four countries in Eastern and Southern Africa (Kenya, Malawi, Mozambique, and Uganda) collected from 2017-2018 as part of the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity (MCS-A). Information was extracted from women's medical records and their participation in audio computer-assisted self-interviews (ACASI). Based on a question in the ACASI, "Did you encounter any anxiety or stress during your hospital stay?", the percentage of women who self-reported feeling anxious/stressed during their facility stay was calculated. Generalized estimating equations were used to identify the determinants of anxiety/stress following a hierarchical approach whereby potential determinants were grouped from most distal to most proximal and analyzed accordingly. RESULTS There were 1254 women with abortion-related complications included in the analysis, of which 56.5% self-reported that they felt anxious/stressed during their facility stay. We found evidence that lower socioeconomic status, lower levels of education, no previous childbirth, no previous abortion, higher gestational age at abortion, and use of unsafe methods of abortion were independent determinants of self-reporting anxiety/stress. CONCLUSIONS Action should be taken to reduce experience of anxiety/stress among women attending facilities for postabortion complications, including reducing the number of women experiencing abortion-related complications by improving access to safe abortion. This issue warrants further study using more comprehensive and validated tools to understand the levels and drivers of anxiety/stress self-reported by women attending facilities with abortion-related complications.
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Affiliation(s)
- Jyoti Pershad
- Independent Researcher, Jersey City, New Jersey, USA
| | | | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Rachidatou Compaoré
- Institut de Recherche en Science de la Santé, Ouagadougou, Burkina Faso.,Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Luis Gadama
- College of Medicine, Department of Obstetrics and Gynecology, University of Malawi, Zomba, Malawi
| | - Philip Govule
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Zahida Qureshi
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Ӧzge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Complicated Grief After the Loss of a Baby: A Systematic Review About Risk and Protective Factors for Bereaved Women. TRENDS IN PSYCHOLOGY 2022. [PMCID: PMC8747442 DOI: 10.1007/s43076-021-00112-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study sought to identify the factors associated with the development and prevention of complicated grief in women who have lost a baby. This is a systematic review of scientific articles in the main mental health databases: MEDLINE (PubMed), EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), and APA Databases (PsycINFO). The selection and data extraction processes occurred independently and blindly by two authors, considering the eligibility criteria. The analysis included publications from 2013 to 2021 of observational studies with adult women who had experienced losing a baby (during pregnancy up to 2 years of life) and that employed standardized instruments to evaluate grief. From the 8,200 records found, 23 articles were selected for analysis. As risk factors, we identified the presence of mother’s psychopathology, history of gestational loss, and social pressure for a new pregnancy, while as protective factors, we identified the presence of another child other than the deceased one, the quality of specialized healthcare, and the social support provided by either a partner, community, or spiritual activities. Furthermore, the studies pointed to the event of losing a baby as an opportunity for posttraumatic growth. Although complicated grief is often associated with other mental health conditions, such as anxiety, depression, or posttraumatic stress, it is necessary to differentiate it for a clearer understanding of the complicated grief as a singular condition, to enable access to appropriate care for bereaved mothers and families, as well as to promote public policies which provide support to them.
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Della Corte L, La Rosa VL, Cassinese E, Ciebiera M, Zaręba K, De Rosa N, Verrazzo P, Improda FP, Vitale SG, Giampaolino P, Commodari E, Bifulco G. Prevalence and associated psychological risk factors of postpartum depression: a cross-sectional study. J OBSTET GYNAECOL 2021; 42:976-980. [PMID: 34907860 DOI: 10.1080/01443615.2021.1980512] [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] [Indexed: 10/19/2022]
Abstract
This cross-sectional study aimed to evaluate the prevalence of postpartum depression and the associated risk factors in a sample of Italian women at three months after delivery. Eighty women were screened by completing the Edinburgh Postnatal Depression Scale (EPDS). Women with a score ≥10 were evaluated as positive and other variables were detected through the administration of the Postpartum Depression Predictors Inventory.The prevalence of postpartum depression in the sample was 11.25% (EPDS score >10). A statistically significant relationship was found between the predisposition to postnatal depression and various risk factors such as prenatal depression, stressful life experiences marital problems. Furthermore, strong emotional and instrumental support from the partner and a good economic status can represent protective factors. It is essential to promote an integrated approach to postpartum affective disorders in which psychosocial risk factors are taken into account, and adequate screening programs are implemented.Impact StatementWhat is already known on this subject? Pregnancy can cause emotional stress for women with consequent development, in some cases, of mood disorders such as postpartum depression.What do the results of this study add? According to this study, women suffering from postpartum depression showed a significant tendency to anxiety and depression, low perceived support from the partner, and low socio-economic status.What are the implications of these findings for clinical practice and/or further research? It would be desirable to promote an integrated approach to postpartum affective disorders in which psychosocial risk factors are taken into account and adequate screening programs are implemented.
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Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Napoli, Italy
| | | | - Eliana Cassinese
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Napoli, Italy
| | - Michał Ciebiera
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Kornelia Zaręba
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Nicoletta De Rosa
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Napoli, Italy
| | - Paolo Verrazzo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Napoli, Italy
| | - Francesco Paolo Improda
- Department of Public Health, School of Medicine, University of Naples Federico II, Napoli, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Napoli, Italy
| | - Elena Commodari
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Napoli, Italy
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11
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Tucker Edmonds B, McKenzie F, O'Donnell B, Panoch J, Hoffman SM, Kavanaugh K, Kuppermann M. 'Expert advice' for developing decision support: A qualitative study of women who have experienced periviable birth. PATIENT EDUCATION AND COUNSELING 2021; 104:2565-2570. [PMID: 33726986 DOI: 10.1016/j.pec.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To elicit advice from women who have experienced periviable birth to optimize periviable counseling, care, and decision support. METHODS We conducted a qualitative study among 21 women who experienced periviable deliveries within three years. Using semi-structured interviews, we asked participants what advice they would offer providers and women/families based on their own experiences. Interviews were independently coded by three trained coders. RESULTS For providers: Participants said to be 'patient' and appreciate the novelty of each family's experience. They suggested being 'realistic' and 'factual'; favored joint OB/Neonatology counseling; and encouraged providers to attend to maternal guilt and self-blame. For women/families: They encouraged asking questions, avoiding the internet, and finding joy in whatever time they had with their child. For hospitals: They advocated for changes to facilitate more mother/baby contact. CONCLUSION Providers can support parents by presenting facts, showing empathy and patience, and reassuring women that they are not to blame. This study highlights patient perspectives to improve interactions with providers, optimize women/families' experiences, and advance efforts toward developing patient-centered systems of periviable care. PRACTICE IMPLICATIONS Women who experience periviable birth desire counseling that is empathetic and 'realistic', encouragement to ask questions, and reassurance that outcomes are not their fault.
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Affiliation(s)
| | - Fatima McKenzie
- Indiana University School of Medicine, Department of OB/GYN, Indianapolis, USA
| | - Betsy O'Donnell
- University of California San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, USA
| | - Janet Panoch
- Indiana University School of Medicine, Department of OB/GYN, Indianapolis, USA
| | - Shelley M Hoffman
- Indiana University School of Medicine, Department of OB/GYN, Indianapolis, USA
| | | | - Miriam Kuppermann
- University of California San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, USA
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12
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González-Ramos Z, Zuriguel-Pérez E, Albacar-Riobóo N, Casadó-Marín L. The emotional responses of women when terminating a pregnancy for medical reasons: A scoping review. Midwifery 2021; 103:103095. [PMID: 34320417 DOI: 10.1016/j.midw.2021.103095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND In most countries of the world the only basis for considering a termination of pregnancy is for medical reasons. Depending on the circumstances and determinants of each case, the emotional responses to this event vary greatly. The aim of this study is to map the emotional responses of women when their pregnancy is terminated for medical reasons. METHODS A scoping review was carried out. This covered all types of qualitative and quantitative studies published in English or Spanish since 2014 which included first-person accounts of women's emotional responses when they had a termination. A bibliographic search was made of four databases (CINAHL, Cochrane Library, PsycINFO and Pubmed) along with an additional manual search and backward and forward citation chaining of the studies included. The data were reported in narrative form and the results grouped according to the descriptive characteristics of the study and the emotions involved. FINDINGS The review process resulted in the inclusion of thirty-four studies. nineteen of these followed a qualitative approach and fifteen used quantitative methodology, with six of them being intervention studies. The emotions found ranged from anxiety and depression to guilt and thankfulness, so various authors stressed the need to improve training for health professionals to provide information, advice and support to the women during the entire process of the termination of pregnancy for medical reasons. CONCLUSIONS The available studies cannot be compared given the variety of designs. The predominant emotions underlying the termination for medical reasons were stress, anxiety and depression. Future research should be carried out using samples of participants covering all causes of termination for medical reasons in a particular context so that an intervention can be designed to help lessen the impact of the process on women's mental health.
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Affiliation(s)
- Zuleika González-Ramos
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain; Hospital Vall d'Hebron. Passeig de la Vall d'Hebron, 119-129, Postal Code 08035 Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain; Hospital Vall d'Hebron. Passeig de la Vall d'Hebron, 119-129, Postal Code 08035 Barcelona, Spain
| | - Núria Albacar-Riobóo
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain
| | - Lina Casadó-Marín
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain
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Hendriks MJ, Abraham A. Perinatal loss and parental loneliness: Narratives of late termination of pregnancy. DEATH STUDIES 2021; 46:1490-1500. [PMID: 33750278 DOI: 10.1080/07481187.2021.1894511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Advances in perinatal medicine, present increasing numbers of women with difficult decisions about their pregnancy. We explored the views of 5 parents and 5 perinatal healthcare professionals regarding late termination of pregnancy following the principles of qualitative content analysis. Parents deciding on whether to (dis)continue pregnancy needed more time and decisional support. Decentralized care and lacking continuity between caregivers led to negative experiences. No standardized bereavement services were offered after leaving the hospital. Integrating principles of perinatal palliative care to care might help to offer further decisional support and to overcome the fragmentation of care.
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Affiliation(s)
- M J Hendriks
- Newborn Research, Department of Neonatology, Clinical Ethics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - A Abraham
- Dialog Ethics, Interdisciplinary Institute of Ethics in Health Care, Zurich, Switzerland
- Institute of Social Anthropology, University of Bern, Bern, Switzerland
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Sanchez C, Grzenda A, Varias A, Widge AS, Carpenter LL, McDonald WM, Nemeroff CB, Kalin NH, Martin G, Tohen M, Filippou-Frye M, Ramsey D, Linos E, Mangurian C, Rodriguez CI. Social media recruitment for mental health research: A systematic review. Compr Psychiatry 2020; 103:152197. [PMID: 32992073 PMCID: PMC7704547 DOI: 10.1016/j.comppsych.2020.152197] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/14/2020] [Accepted: 08/06/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Social media holds exciting promise for advancing mental health research recruitment, however, the extent and efficacy to which these platforms are currently in use are underexplored. OBJECTIVE A systematic review was conducted to characterize the current use and efficacy of social media in recruiting participants for mental health research. METHOD A literature review was performed using MEDLINE, EMBASE, and PsychINFO. Only non-duplicative manuscripts written in the English language and published between 1/1/2004-3/31/2019 were selected for further screening. Data extracted included study type and design, participant inclusion criteria, social media platform, advertising strategy, final recruited sample size, recruitment location, year, monetary incentives, comparison to other recruitment methods if performed, and final cost per participant. RESULTS A total of 176 unique studies that used social media for mental health research recruitment were reviewed. The majority of studies were cross-sectional (62.5%) in design and recruited adults. Facebook was overwhelmingly the recruitment platform of choice (92.6%), with the use of paid advertisements being the predominant strategy (60.8%). Of the reviewed studies, substance abuse (43.8%) and mood disorders (15.3%) were the primary subjects of investigation. In 68.3% of studies, social media recruitment performed as well as or better than traditional recruitment methods in the number and cost of final enrolled participants. The majority of studies used Facebook for recruitment at a median cost per final recruited study participant of $19.47. In 55.6% of the studies, social media recruitment was the more cost-effective recruitment method when compared to traditional methods (e.g., referrals, mailing). CONCLUSION Social media appears to be an effective and economical recruitment tool for mental health research. The platform raises methodological and privacy concerns not covered in current research regulations that warrant additional consideration.
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Affiliation(s)
- Catherine Sanchez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Adrienne Grzenda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Andrea Varias
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Alik S Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
| | - Linda L Carpenter
- Department of Psychiatry and Human Behavior, Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - William M McDonald
- Department of Psychiatry and Human Behavior, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles B Nemeroff
- Department of Psychiatry, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Glenn Martin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Maria Filippou-Frye
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Drew Ramsey
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University, Stanford, CA, USA
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA; UCSF Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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15
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Blackwell S, Louis JM, Norton ME, Lappen JR, Pettker CM, Kaimal A, Landy U, Edelman A, Teal S, Landis R. Reproductive services for women at high risk for maternal mortality: a report of the workshop of the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Fellowship in Family Planning, and the Society of Family Planning. Am J Obstet Gynecol 2020; 222:B2-B18. [PMID: 32252942 DOI: 10.1016/j.ajog.2019.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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16
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Google AdWords and Facebook Ads for Recruitment of Pregnant Women into a Prospective Cohort Study With Long-Term Follow-Up. Matern Child Health J 2020; 23:1285-1291. [PMID: 31222599 PMCID: PMC6732125 DOI: 10.1007/s10995-019-02797-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives Several types of epidemiologic studies suffer from decreasing participation rates, resulting in potential selection bias and delay or termination of studies. We aimed to determine the feasibility of online methods for recruitment of pregnant women into a prospective cohort study. Methods In addition to traditional recruitment through prenatal care providers, we advertized participation in the PRegnancy and Infant DEvelopment (PRIDE) Study, an ongoing prospective cohort study with long-term follow-up in The Netherlands enrolling women in early pregnancy, through Google AdWords (30 days) and Facebook Ads (31 and 27 days) campaigns between September 2016 and January 2017. We calculated costs per eligible participant and compared demographics, health-related characteristics, and follow-up rates between participants recruited through online methods and prenatal care providers. Results During the study period, we recruited six women through AdWords (€54.28 per participant), 59 through Facebook (€10.17 per participant), and 327 through prenatal care providers (no valid cost estimate available). Facebook participants seemed to be younger (29.0 vs. 30.7 years), to have a higher body mass-index and/or low/intermediate education (27.0 vs. 24.0 kg/m2 and 41 vs. 25%, respectively), and to start prenatal care in secondary care more often (12 vs. 5%) than participants recruited through prenatal care providers. Item non-response and loss to follow-up rates were higher among women recruited online than among those recruited through prenatal care providers. Conclusion Google AdWords did not contribute substantially, but Facebook Ads may complement traditional recruitment methods of pregnant women into prospective cohort studies, despite challenges that may threaten internal validity.
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17
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Kerns JL, Turk JK, Corbetta-Rastelli CM, Rosenstein MG, Caughey AB, Steinauer JE. Second-trimester abortion attitudes and practices among maternal-fetal medicine and family planning subspecialists. BMC Womens Health 2020; 20:20. [PMID: 32013926 PMCID: PMC6998287 DOI: 10.1186/s12905-020-0889-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients deciding to undergo dilation and evacuation (D&E) or induction abortion for fetal anomalies or complications may be greatly influenced by the counseling they receive. We sought to compare maternal-fetal medicine (MFM) and family planning (FP) physicians' attitudes and practice patterns around second-trimester abortion for abnormal pregnancies. METHODS We surveyed members of the Society for Maternal-Fetal Medicine and Family Planning subspecialists in 2010-2011 regarding provider recommendations between D&E or induction termination for various case scenarios. We assessed provider beliefs about patient preferences and method safety regarding D&E or induction for various indications. We compared responses by specialty using descriptive statistics and conducted unadjusted and adjusted analyses of factors associated with recommending a D&E. RESULTS Seven hundred ninety-four (35%) physicians completed the survey (689 MFMs, 105 FPs). We found that FPs had 3.9 to 5.5 times higher odds of recommending D&E for all case scenarios (e.g. 80% of FPs and 41% of MFMs recommended D&E for trisomy 21). MFMs with exposure to family planning had greater odds of recommending D&E for all case scenarios (p < 0.01 for all). MFMs were less likely than FPs to believe that patients prefer D&E and less likely to feel that D&E was a safer method for different indications. CONCLUSION Recommendations for D&E or induction vary significantly depending on the type of physician providing the counseling. The decision to undergo D&E or induction is one of clinical equipoise, and physicians should provide unbiased counseling. Further work is needed to understand optimal approaches to shared decision making for this clinical decision.
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Affiliation(s)
- J. L. Kerns
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110 USA
| | - J. K. Turk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110 USA
| | - C. M. Corbetta-Rastelli
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA
| | - M. G. Rosenstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110 USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA
| | - A. B. Caughey
- Department of Obstetrics and Gynecology of Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 USA
| | - J. E. Steinauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110 USA
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Alfaro Blazquez R, Ferrer Ferrandiz E, Gea Caballero V, Corchon S, Juarez-Vela R. Women's satisfaction with maternity care during preterm birth. Birth 2019; 46:670-677. [PMID: 31531890 DOI: 10.1111/birt.12453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/10/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women's satisfaction with maternity care is strongly influenced by their sociodemographic characteristics, values, and attitudes. The arrival of a preterm baby is often a traumatic time, with unique factors involved. The Spanish Preterm Birth Experience and Satisfaction Scale (P-BESS) is a robust instrument capable of assessing women's satisfaction during preterm birth. The purpose of this study was to assess women's satisfaction with maternity care during labor and birth with preterm babies in a Spanish-speaking population. METHODS This is a cross-sectional study. Participants were 182 women who gave birth within 37 weeks' gestation. Factors associated with satisfaction were studied through univariate and bivariate analyses and through multiple linear regression using the backward elimination method. RESULTS Women reported high satisfaction with maternity care overall (average score of 84 out of 95). Women with a university education were generally less satisfied. Women were more satisfied if they were pregnant for the first time. Women who reported a previous premature birth or neonatal death were more satisfied, and women who had prior miscarriages were less satisfied compared with women without these experiences. CONCLUSIONS The analysis confirmed that the majority of women surveyed were very satisfied with their childbirth experience. The Spanish P-BESS can be a useful way of prioritizing intervention measures, focusing on those aspects lowest scored by women, such as "information and explanations" and "confidence in staff," to improve maternity services for families experiencing preterm birth.
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Affiliation(s)
- Ruben Alfaro Blazquez
- Department of Obstetrics, University and Polytechnic Hospital "La Fe", Valencia, Spain.,School of Nursing and Podiatry, University of Valencia, Valencia, Spain
| | - Esperanza Ferrer Ferrandiz
- Nursing School "La Fe", University of Valencia, Valencia, Spain.,Nursing Research Group in Art and Science of Care (GREIACC), Valencia, Spain
| | - Vicente Gea Caballero
- Nursing School "La Fe", University of Valencia, Valencia, Spain.,Nursing Research Group in Art and Science of Care (GREIACC), Valencia, Spain
| | - Silvia Corchon
- School of Nursing and Podiatry, University of Valencia, Valencia, Spain
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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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20
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The patient perspective: perceptions of the quality of the abortion experience. Curr Opin Obstet Gynecol 2019; 30:407-413. [PMID: 30299320 DOI: 10.1097/gco.0000000000000492] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Abortion services are essential in sexual and reproductive health and should be held to the same standards as other health services. Patient (or person)-centeredness is a key dimension of healthcare quality that incorporates the perspectives of patients in care provision. The purpose of this review is to summarize studies published in the last year examining women's experiences with abortion care and to describe facilitators and barriers to person-centered care. RECENT FINDINGS Considering person-centeredness in abortion care using dimensions of dignity, autonomy, privacy, communication, social support, supportive care and health facility environment allows for critical evaluation of data describing women's experiences with abortion and postabortion services. Review of the available literature shed light on the impact of social stigma, health policy and abortion restrictions on women's abortion experiences. SUMMARY Considering multiple domains and varied settings, current data suggest abortion services worldwide generally fail to provide person-centered care. Institutions and providers may be limited in their ability to provide patient-centered abortion care because of deeply embedded social stigma, institutional regulations and legal restrictions.
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Lou S, Carstensen K, Vogel I, Hvidman L, Nielsen CP, Lanther M, Petersen OB. Receiving a prenatal diagnosis of Down syndrome by phone: a qualitative study of the experiences of pregnant couples. BMJ Open 2019; 9:e026825. [PMID: 30867204 PMCID: PMC6429881 DOI: 10.1136/bmjopen-2018-026825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To examine how pregnant couples experience receiving a prenatal diagnosis of Down syndrome (DS) by phone-a practice that has been routine care in the Central Denmark Region for years. DESIGN Qualitative interview study. SETTING Participants were recruited from hospitals in Central Denmark Region, Denmark. PARTICIPANTS Couples who had received a prenatal diagnosis of DS by phone and decided to terminate the pregnancy. They were recruited from the obstetric department where the termination was undertaken. During the study period (February 2016 to July 2017), 21 semistructured, audio-recorded interviews were conducted by an experienced anthropologist. Interviews were conducted 4-22 weeks after the diagnosis and analysed using thematic analysis. RESULTS A prearranged phone call was considered an acceptable practice. However, the first theme 'Expected but unexpected' shows how the call often came earlier than expected. Consequently, most women were not with their partner and were thus initially alone with their grief and furthermore responsible for informing their partner, which some considered difficult. The second theme 'Now what?' shows how during the phone calls, physicians were quick to enquire about the couples' agendas. As the majority had already decided to seek termination of pregnancy, the dialogue focused on related questions and arrangements. Only half of the couples received additional counselling. CONCLUSION A prearranged phone call was considered an acceptable and appropriate practice. However, some aspects of this practice (particularly related to the context of the call) showed to be less than optimal for the couples. To make sure that a diagnostic result is delivered in accordance with the couples' needs and requests, the context of the call could be addressed and agreed on in advance by physicians and couples.
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Affiliation(s)
- Stina Lou
- Central Denmark Region, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Carstensen
- Central Denmark Region, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus Universitetshospital, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus Universitetshospital, Aarhus, Denmark
| | | | - Maja Lanther
- Central Denmark Region, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus Universitetshospital, Aarhus, Denmark
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Ali MK, Botros HA, Mostafa SA. Foley's catheter balloon for induction of mid-trimester missed abortion with or without traction applied: a randomized controlled trial. J Matern Fetal Neonatal Med 2018; 33:198-205. [PMID: 29886787 DOI: 10.1080/14767058.2018.1487949] [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: 02/02/2023]
Abstract
Objective: To determine whether the traction placed on a transcervical Foley catheter balloon inserted for the induction of mid-trimester missed abortion results in faster time of abortion.Study design: It was randomized clinical trial conducted at Assiut Woman's Health Hospital, Egypt, from September 2016 to August 2017 on women with missed abortion in the mid-trimester. Participants were randomly assigned to transcervical Foley catheter balloon insertion with or without traction. The primary outcome of this study was insertion to abortion time. The secondary outcomes included insertion to catheter expulsion time, vaginal bleeding, and pain associated with insertion. The outcome variables were analyzed using Mann-Whitney U and chi-square tests. A logistic regression model was utilized to examine the association between patient's characteristics and the failure of Foley catheter balloon expulsion within 24 hours.Results: Two hundred women were recruited (100 women in each group). The insertion to abortion time was significantly shorter in group I (traction group) than group II (no traction group) (16.49 ± 2.59 versus 18.24 ± 3.30 hours; p = .000). Insertion to balloon expulsion time in group I was also significantly short (7.92 ± 0.86 versus 9.12 ± 1.19 hours; p = .000). However, a significantly higher rate of vaginal bleeding and a higher degree of pain were reported by the women in group I (p = .008, p = .000; respectively). The nulliparity, longer interpregnancy interval (>22 months), smaller gestational age (<14 weeks) and lower Bishop Score before insertion (<2) were significantly associated with a higher likelihood of Foley catheter balloon expulsion failure within 24 hours.Conclusion: The small time advantage of traction does not compensate for the downsides of traction, mainly pain, analgesic use, and vaginal bleeding.
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Affiliation(s)
- Mohammed K Ali
- Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Heba A Botros
- Department of Obstetrics & Gynecology, El Eman Hospital for Woman and Child, Assiut, Egypt
| | - Sayed A Mostafa
- Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
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