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Gandhi C, Page J. Stillbirth risk factors, causes and evaluation. Semin Perinatol 2024; 48:151867. [PMID: 38163743 DOI: 10.1016/j.semperi.2023.151867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Stillbirth impacts 5.73 per 1,000 births in the United States and this rate exceeds that of contemporary high-resource countries.1,2 Risk factors include both demographic and medical characteristics. There are also numerous pathophysiologic mechanisms that can lead to stillbirth. Unfortunately, these risk factors are fairly common, making stillbirth risk stratification and prevention challenging. This is due in part to a large number of unexplained stillbirths. In a large, multi-center study of stillbirths, approximately 24% of stillbirths remained unexplained following thorough, standardized evaluation.3 The number of unexplained stillbirths is unquestionably larger outside of a rigorous study protocol, but real-world data are lacking. This large proportion of unexplained stillbirth cases makes achieving further decreases in the stillbirth rate difficult given lack of understanding of underlying causes in this population. Cause of death identification can be improved with adoption of an evidence-based, comprehensive stillbirth evaluation.
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Affiliation(s)
- Christy Gandhi
- Columbia University Irving Medical Center, United States.
| | - Jessica Page
- Intermountain Health, University of Utah, United States
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2
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Kim C, Khong TY. Participation of perinatal pathologists in seeking consent for autopsies. Pathology 2023; 55:1020-1022. [PMID: 37544874 DOI: 10.1016/j.pathol.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/20/2023] [Accepted: 05/07/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Chankyung Kim
- Department of Anatomical Pathology, SA Pathology, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia.
| | - Teck Yee Khong
- Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia; Department of Anatomical Pathology, SA Pathology at Women's and Children's Hospital, Adelaide, SA, Australia
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3
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Sergi CM, Mullur T. Life and Death Sometimes Coincide, and Pastoral Response is Crucial to the Brokenhearted. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2022; 76:281-284. [PMID: 35946112 DOI: 10.1177/15423050221118027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Perinatal loss may remain unexplained, despite current technology, modern preventive care measures, and advanced diagnostic procedures. Culturally sensitive and competent discussions should be prioritized in medicine, but religious and spiritual feelings are often marginalized. Here we highlight our reflections on the importance of the spiritual and theological responses to parents grieving stillbirth. Chaplains are critical for the wellbeing of both families and physicians.
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Affiliation(s)
- Consolato M Sergi
- Institute of Pathology, Medical University of Innsbruck, Austria Anatomic Pathology Division, Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, ON, Canada
- Department of Pastoral and Spiritual Care, Medical University of Innsbruck, Austria
| | - Tomy Mullur
- 31222Tiroler Landeskrankenanstalten GmbH (TILAK), Pastoral Care, Austria
- Department of Pastoral and Spiritual Care, Medical University of Innsbruck, Austria
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4
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Heys S, Rhind S, Tunn J, Shethwood K, Henry J. An exploration of maternity and newborn exposure, training and education among staff working within the North West Ambulance Service. Br Paramed J 2022; 7:50-57. [PMID: 36447999 PMCID: PMC9662155 DOI: 10.29045/14784726.2022.09.7.2.50] [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: 09/08/2023] Open
Abstract
AIM Providing emergency and urgent care to pregnant patients and newborns in the pre-hospital setting often presents some of the most challenging and complex incidents attended to by ambulance staff. A service evaluation survey was undertaken to explore current levels of maternity and newborn education, preferred methods of training delivery, exposure and perceived support surrounding maternity and newborn care provision among pre-hospital clinicians working within the North West Ambulance Service (NWAS) NHS Trust. METHODS An online, anonymised survey compromising of 22 questions using multiple choice options and free-text questions was circulated among NWAS staff between 27 May 2021 and 21 June 2021. Questions explored the levels of training, education, exposure and confidence relating to maternal and newborn care in the pre-hospital setting. Insights into preferred approaches to engaging with continuing professional development (CPD) activities were also captured. Data were analysed using built-in Microsoft Forms analytics for quantitative response, with a basic thematic analysis undertaken to synthesise qualitative responses. RESULTS The survey received 509 responses, with data providing valuable insight relating to gaps in training provision, preferred approaches to CPD and barriers to engagement. Key themes focused on 'pre-registration standards and variations', 'barriers and facilitators to continuing professional development' and 'exposure and skill decline: confidence and knowledge'. CONCLUSION Areas for service improvement are highlighted, providing ambulance trusts and integrated care systems with key recommendations. These include maternity and newborn standards for education among paramedic science degree programmes; recognition of pre-hospital emergency maternity and newborn care among maternity providers; the need for exposure and regular multidisciplinary team (MDT) skills training for staff; and a collaborative system-led approach to scaling up and delivering MDT training that acknowledges pre-hospital clinicians as key care providers.
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Affiliation(s)
- Stephanie Heys
- North West Ambulance Service NHS Trust; University of Central Lancashire
| | | | | | - Kate Shethwood
- North West Ambulance Service NHS Trust; Health Education England
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5
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Muin DA, Neururer S, Rotter V, Leitner H, Leutgeb S, Husslein PW, Kiss H, Kohlberger P. Institutional guidelines on maternal care and investigations following antepartum stillbirth - a national survey. BMC Pregnancy Childbirth 2021; 21:528. [PMID: 34303351 PMCID: PMC8305903 DOI: 10.1186/s12884-021-03995-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/09/2021] [Indexed: 02/05/2023] Open
Abstract
Background Antepartum stillbirth, i.e., intrauterine fetal death (IUFD) above 24 weeks of gestation, occurs with a prevalence of 2.4–3.1 per 1000 live births in Central Europe. In order to ensure highest standards of treatment and identify causative and associated (risk) factors for fetal death, evidence-based guidelines on clinical practice in such events are recommended. Owing to a lack of a national guideline on maternal care and investigations following stillbirth, we, hereby, sought to assess the use of institutional guidelines and clinical practice after IUFD in Austrian maternity units. Methods A national survey with a paper-based 12-item questionnaire covering demographic variables, local facilities and practice, obstetrical care and routine post-mortem work-up following IUFD was performed among all Austrian secondary and tertiary referral hospitals with maternity units (n = 75) between January and July 2019. Statistical tests were conducted using Chi2 and Fisher’s Exact test, respectively. Univariate logistic regression analyses were performed to calculate odds ratio (OR) with a 95% confidence interval (CI). Results 46 (61.3%) obstetrical departments [37 (80.4%) secondary; 9 (19.6%) tertiary referral hospitals] participated in this survey, of which 17 (37.0%) have implemented an institutional guideline. The three most common investigations always conducted following stillbirth are placental histology (20.9%), fetal autopsy (13.1%) and maternal antibody screen (11.5%). Availability of an institutional guideline was not significantly associated with type of hospital, on-site pathology department, or institutional annual live and stillbirth rates. Post-mortem consultations only in cases of abnormal investigations following stillbirth were associated with lower odds for presence of such guideline [OR 0.133 (95% CI 0.018–0.978); p = 0.047]. 26 (56.5%) departments consider a national guideline necessary. Conclusions Less than half of the surveyed maternity units have implemented an institutional guideline on maternal care and investigations following antepartum stillbirth, independent of annual live and stillbirth rate or type of referral centre. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03995-z.
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Affiliation(s)
- Dana A Muin
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Sabrina Neururer
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Anichstraße 35, 6020, Innsbruck, Austria
| | - Veronika Rotter
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Hermann Leitner
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Anichstraße 35, 6020, Innsbruck, Austria
| | - Stephanie Leutgeb
- Austrian Society of Obstetrics and Gynecology, Frankgasse 8, 1090, Vienna, Austria
| | - Peter W Husslein
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Austrian Society of Obstetrics and Gynecology, Frankgasse 8, 1090, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Austrian Society of Obstetrics and Gynecology, Frankgasse 8, 1090, Vienna, Austria
| | - Petra Kohlberger
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Austrian Society of Obstetrics and Gynecology, Frankgasse 8, 1090, Vienna, Austria
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6
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Nuzum D, Fitzgerald B, Evans MJ, O'Donoghue K. Maternity Healthcare Chaplains and Perinatal Post-Mortem Support and Understanding in the United Kingdom and Ireland: An Exploratory Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:1924-1936. [PMID: 33415602 DOI: 10.1007/s10943-020-01176-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
Perinatal autopsy rates have declined significantly in recent decades. There is a lack of consensus concerning the potential religious influences for bereaved parents in their decision making process for post-mortem. This online study of British and Irish maternity healthcare chaplains explored their understanding of general and local perinatal post-mortem procedures and their experiences in the support of parents. Participants included Christian, Muslim and non-faith chaplains. No chaplain identified any religious prohibition to perinatal post-mortem. A majority of chaplains reported that they had been asked about post-mortem by parents; only a minority felt adequately prepared. A key recommendation is that following appropriate training chaplains may be well placed to support colleagues and parents during the decision making process.
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Affiliation(s)
- D Nuzum
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - B Fitzgerald
- Department of Histopathology, Cork University Hospital, Wilton, Cork, Ireland
| | - M J Evans
- Department of Pathology, Edinburgh Royal Infirmary, Edinburgh, Scotland
- Honorary Professor, Department of Molecular, Genetic and Population Health Studies, University of Edinburgh, Edinburgh, Scotland
| | - K O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
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7
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Reed K, Ferazzoli MT, Whitby E. "Why didn't we do it"? Reproductive loss and the problem of post-mortem consent. Soc Sci Med 2021; 276:113835. [PMID: 33780832 DOI: 10.1016/j.socscimed.2021.113835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
Informed consent has been a much debated topic within the social sciences. It often forms a central feature of discussions on research in medical settings and in social research methods more broadly. While sympathetic to its' underlying principles of autonomy and choice, social scientists have tended to argue that these are seldom enacted in research or clinical practice. Rather, such principles are often circumscribed by wider social structures and by a culture of medical dominance. Drawing on data from a qualitative study on perinatal post-mortem, this paper explores informed consent in the emotionally charged clinical arena of perinatal pathology. Our in-depth analysis will provide fresh insight into post-mortem decision-making in the sensitive arena of baby loss. Our findings show how parents often found it difficult to give consent for post-mortem, and also for professionals to take consent from parents. It was also not uncommon for parents to experience regret over non-consent later on. One of our key findings, however, related to the sense of emotional and diagnostic closure often afforded by post-mortem when consent had been given. We conclude by arguing that, although we cannot resolve the tension between the principles of consent and their enactment in practice, we can develop a reflexive approach with which to navigate the process. In doing so, the paper contributes to wider sociological discussions on the meaning and use of informed consent in various settings beyond medical contexts.
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Affiliation(s)
- Kate Reed
- Department of Sociological Studies, University of Sheffield, Elmfield Building, Northumberland Road, Sheffield, S10 2TU, UK.
| | - Maria Teresa Ferazzoli
- University of Sheffield, Department of Sociological Studies, Elmfield, Northumberland Road, Sheffield, S10 2TU, UK.
| | - Elspeth Whitby
- Clinical Senior Lecturer/Honorary Consultant, University of Sheffield, Department of Oncology and Metabolism, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
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8
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Lewis C, Hutchinson JC, Riddington M, Hill M, Arthurs OJ, Fisher J, Wade A, Doré CJ, Chitty LS, Sebire NJ. Minimally invasive autopsy for fetuses and children based on a combination of post-mortem MRI and endoscopic examination: a feasibility study. Health Technol Assess 2020; 23:1-104. [PMID: 31461397 DOI: 10.3310/hta23460] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Less invasive perinatal and paediatric autopsy methods, such as imaging alongside targeted endoscopy and organ biopsy, may address declining consent rates for traditional autopsy, but their acceptability and accuracy are not known. OBJECTIVES The aims of this study were to provide empirical data on the acceptability and likely uptake for different types of autopsy among key stakeholders (study 1); and to analyse existing autopsy data sources to provide estimates of the potential efficacy of less invasive autopsy (LIA) and its projected utility in clinical practice (study 2). REVIEW METHODS Study 1: this was a mixed-methods study. Parents were involved in research design and interpretation of findings. Substudy 1: a cross-sectional survey of 859 parents who had experienced miscarriage, termination of pregnancy for fetal anomaly, stillbirth, infant or child death, and interviews with 20 responders. Substudy 2: interviews with 25 health professionals and four coroners. Substudy 3: interviews with 16 religious leaders and eight focus groups, with 76 members of the Muslim and Jewish community. Study 2: a retrospective analysis of national data in addition to detailed information from an existing in-house autopsy database of > 5000 clinical cases that had undergone standard autopsy to determine the proportion of cases by clinical indication group for which tissue sampling of specific internal organs significantly contributed to the diagnosis. RESULTS Substudy 1: 91% of participants indicated that they would consent to some form of LIA, 54% would consent to standard autopsy, 74% to minimally invasive autopsy (MIA) and 77% to non-invasive autopsy (NIA). Substudy 2: participants viewed LIA as a positive development, but had concerns around the limitations of the technology and de-skilling the workforce. Cost implications, skills and training requirements were identified as implementation challenges. Substudy 3: religious leaders agreed that NIA was religiously permissible, but MIA was considered less acceptable. Community members indicated that they might consent to NIA if the body could be returned for burial within 24 hours. Study 2: in 5-10% of cases of sudden unexplained death in childhood and sudden unexplained death in infants, the final cause of death is determined by routine histological sampling of macroscopically normal organs, predominantly the heart and lungs, and in this group routine histological sampling therefore remains an important aspect of investigation. In contrast, routine histological examination of macroscopically normal organs rarely (< 0.5%) provides the cause of death in fetal cases, making LIA and NIA approaches potentially highly applicable. LIMITATIONS A key limitation of the empirical research is that it is hypothetical. Further research is required to determine actual uptake. Furthermore, because of the retrospective nature of the autopsy data set, findings regarding the likely contribution of organ sampling to final diagnosis are based on extrapolation of findings from historical autopsies, and prospective data collection is required to validate the conclusions. CONCLUSIONS LIA is viable and acceptable (except for unexplained deaths), and likely to increase uptake. Further health economic, performance and implementation studies are required to determine the optimal service configuration required to offer this as routine clinical care. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - John C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
| | - Megan Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Angie Wade
- Institute of Child Health; Population, Policy and Practice, University College London, London, UK
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neil J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
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9
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O'Leary BD, Walsh M, Mooney EE, McAuliffe FM, Knowles SJ, Mahony RM, Downey P. The etiology of stillbirth over 30 years: A cross-sectional study in a tertiary referral unit. Acta Obstet Gynecol Scand 2020; 100:314-321. [PMID: 32959373 DOI: 10.1111/aogs.13992] [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: 04/27/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Stillbirth remains an often unpredictable and devastating pregnancy outcome, and despite thorough investigation, the number of stillbirths attributable to unexplained causes remains high. Placental examination has become increasingly important where access to perinatal autopsy is limited. We aimed to examine the causes of stillbirth in normally formed infants over 30 years and whether a declining autopsy rate has affected our ability to determine a cause for stillbirths. MATERIAL AND METHODS All cases of normally formed singleton infants weighing ≥500 g that died prior to the onset of labor from 1989 to 2018 were examined. Trends for specific causes and uptake of perinatal autopsy were analyzed individually. RESULTS In all, 229 641 infants were delivered, with 840 stillbirths giving a rate of 3.66/1000. The rate of stillbirth declined from 4.84/1000 in 1989 to 2.51 in 2018 (P < .001). There was no difference in the rate of stillbirth between nulliparous and multiparous women (4.25 vs 3.66 per 1000, P = .026). Deaths from placental abruption fell (1.13/1000 in 1989 to 0 in 2018, P < .001) and the relative contribution of placental abruption to the incidence of stillbirth also fell, from 23.3% (7/30) in 1989 to 0.0% (0/19) in 2018 (P < .001). Stillbirth attributed to infection remained static (0.31/1000 in 1989 to 0.13 in 2018, P = .131), while a specific causal organism was found in 79.2% (42/53) of cases. Unexplained stillbirths decreased from 2.58/1000 (16/6200) in 1989 to 0.13 (1/7581) in 2018 (P < .001) despite a fall in the uptake of perinatal autopsy (96.7% [29/30] in 1989 to 36.8% (7/19) in 2018; P < .001). Placental disease emerged as a significant cause of stillbirth from 2004 onwards (89.5% [17/19] in 2018). CONCLUSIONS The present analysis is one of the largest single-center studies on stillbirth published to date. Stillbirth rates have fallen across the study period across parity. A decrease in deaths secondary to placental abruption contributed largely to this. Infection-related deaths are static; however, in one-fifth of cases a causative organism was not found. Despite a decreasing autopsy rate, the number of unexplained stillbirths continues to fall as the importance of placental pathology is increasingly recognized.
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Affiliation(s)
- Bobby D O'Leary
- Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.,UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - Molly Walsh
- Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland
| | - Eoghan E Mooney
- Department of Histopathology, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.,UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - Susan J Knowles
- Department of Microbiology, National Maternity Hospital, Dublin, Ireland
| | - Rhona M Mahony
- Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland
| | - Paul Downey
- Department of Histopathology, National Maternity Hospital, Dublin, Ireland
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10
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Evans MJ, Draper ES, Smith LK. Impact of sociodemographic and clinical factors on offer and parental consent to postmortem following stillbirth or neonatal death: a UK population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2020; 105:532-537. [PMID: 31969458 DOI: 10.1136/archdischild-2019-318226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify factors associated with the offer of and consent to perinatal post-mortem. DESIGN National population-based cohort study SETTING: The UK. POPULATION 26 578 perinatal deaths born between 1 January 2013 and 31 December 2017. MAIN OUTCOME MEASURES Postmortem offer by clinical staff; parental consent to post-mortem. RESULTS Postmortem offer rates were high but varied significantly with time of death from 97.8% for antepartum deaths to 88.4% for neonatal deaths following neonatal admission. Offer rates did not significantly vary by gestation, year of birth, mother's socioeconomic deprivation, ethnicity or age. Only 44.5% of parents consented to a postmortem. Mothers from the most deprived areas were less likely to consent than those from the least deprived areas (relative risk (RR)=0.76, 95% CI 0.71 to 0.80). Consent rates were similar for mothers of white, mixed, Asian Indian, black Caribbean and black African ethnicity (43%-47%), but significantly lower for mothers of Asian Pakistani (20%) and Asian Bangladeshi (18%) ethnicity. Consent increased with increasing gestation (p<0.001) and was lower for deaths following neonatal unit admission than for antepartum death (RR 0.71, 95% CI 0.67 to 0.75). CONCLUSIONS The current profile of cause of perinatal deaths in the UK is likely to be biased with less postmortem information available for babies dying in the neonatal period and those born to mothers from deprived areas and of Asian Pakistani or Asian Bangladeshi ethnicity. Such bias severely limits the design of effective strategies for reducing mortality in these high-risk groups. These findings have implications for high-income countries seeking to explore and improve the understanding of perinatal deaths.
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Affiliation(s)
- Margaret J Evans
- Pathology, University of Edinburgh, Edinburgh, UK.,University of Leicester College of Life Sciences, Leicester, UK.,Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Lucy K Smith
- University of Leicester College of Life Sciences, Leicester, UK
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11
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Sauvegrain P, Carayol M, Piedvache A, Guéry E, Bucourt M, Zeitlin J. Low autopsy acceptance after stillbirth in a disadvantaged French district: a mixed methods study. BMC Pregnancy Childbirth 2019; 19:117. [PMID: 30953470 PMCID: PMC6451265 DOI: 10.1186/s12884-019-2261-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 03/25/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Priscille Sauvegrain
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
- Department of Obstetrics and Gynecology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Marion Carayol
- Maternal and Infant Protection Service, Department of Families and Early Childhood, Paris, France
| | - Aurélie Piedvache
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
| | - Esther Guéry
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
| | - Martine Bucourt
- Fetopathology Unit, Jean Verdier Hospital, AP-HP, Bondy, France
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
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12
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Thomson G, Garrett C. Afterbirth support provision for women following a traumatic/distressing birth: Survey of NHS hospital trusts in England. Midwifery 2019; 71:63-70. [DOI: 10.1016/j.midw.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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13
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Schirmann A, Boyle FM, Horey D, Siassakos D, Ellwood D, Rowlands I, Flenady V. Understanding mothers' decision-making needs for autopsy consent after stillbirth: Framework analysis of a large survey. Birth 2018; 45:255-262. [PMID: 29498429 DOI: 10.1111/birt.12344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Experiencing stillbirth is devastating and leaves parents searching for causes. Autopsy is the gold standard for investigation, but deciding to consent to this procedure is very difficult for parents. Decision support in the form of clear, consistent, and parent-centered information is likely to be helpful. The aims of this study were to understand the influences on parents' decisions about autopsy after stillbirth and to identify attributes of effective decision support that align with parents' needs. METHODS Framework analysis using the Decision Drivers Model was used to analyze responses from 460 Australian and New Zealand (ANZ) mothers who took part in a multi-country online survey of parents' experiences of stillbirth. The main outcomes examined were factors influencing mothers' decisions to consent to autopsy after stillbirth. RESULTS Free-text responses from 454 ANZ mothers referenced autopsy, yielding 1221 data segments for analysis. The data confirmed the difficult decision autopsy consent entails. Mothers had a strong need for answers coupled with a strong need to protect their baby. Four "decision drivers" were confirmed: preparedness for the decision; parental responsibility; possible consequences; and role of health professionals. Each had the capacity to influence decisions for or against autopsy. Also prominent were the "aftermath" of the decision: receiving the results; and decisional regret or uncertainty. CONCLUSIONS The influences on decisions about autopsy are diverse and unpredictable. Effective decision support requires a consistent and structured approach that is built on understanding of parents' needs.
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Affiliation(s)
- Anne Schirmann
- School of Public Health, The University of Queensland, Herston, Qld, Australia
| | - Frances M Boyle
- Mater Research Institute-UQ, The University of Queensland, Brisbane, Qld, Australia
| | - Dell Horey
- School of Psychology and Public Health, College of Science, Health and Engineering (SHE), La Trobe University, Bundoora, Vic., Australia
| | - Dimitrios Siassakos
- Centre for Academic Women's Health, University of Bristol, Chilterns, Women's Health, Southmead Hospital, Bristol, UK
| | - David Ellwood
- Department of Obstetrics and Gynaecology, School of Medicine, Griffith University, Gold Coast, Qld, Australia
| | - Ingrid Rowlands
- School of Psychology, The University of Queensland, St Lucia, Qld, Australia
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Qld, Australia
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Lewis C, Latif Z, Hill M, Riddington M, Lakhanpaul M, Arthurs OJ, Hutchinson JC, Chitty LS, Sebire NJ. "We might get a lot more families who will agree": Muslim and Jewish perspectives on less invasive perinatal and paediatric autopsy. PLoS One 2018; 13:e0202023. [PMID: 30092056 PMCID: PMC6085003 DOI: 10.1371/journal.pone.0202023] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 07/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background Perinatal and paediatric autopsy rates are at historically low levels with declining uptake due to dislike of the invasiveness of the procedure, and religious objections particularly amongst Muslim and Jewish parents. Less invasive methods of autopsy including imaging with and without tissue sampling have been shown to be feasible alternatives. We sought to investigate attitudes including religious permissibility and potential uptake amongst members of the Muslim and Jewish communities in the United Kingdom. Methods Semi-structured interviews with religious and faith-based authorities (n = 16) and bereaved parents from the Jewish community (n = 3) as well as 10 focus groups with community members (60 Muslim participants and 16 Jewish participants) were conducted. Data were analysed using thematic analysis to identify key themes. Findings Muslim and Jewish religious and faith-based authorities agreed that non-invasive autopsy with imaging was religiously permissible because it did not require incisions or interference with the body. A minimally invasive approach was less acceptable as it still required incisions to the body, although in those circumstances where it was required by law it was more acceptable than a full autopsy. During focus group discussions with community members, the majority of participants indicated they would potentially consent to a non-invasive autopsy if the body could be returned for burial within 24 hours, or if a family had experienced multiple fetal/pregnancy losses and the information gained might be useful in future pregnancies. Minimally invasive autopsy was less acceptable but around half of participants might consent if a non-invasive autopsy was not suitable, with the exception of the Jewish Haredi community who unanimously stated they would decline this alternative. Conclusions Our research suggests less invasive autopsy offers a viable alternative to many Muslim and Jewish parents in the UK who currently decline a full autopsy. The findings may be of importance to other countries with significant Muslim and/or Jewish communities as well as to other religious communities where concerns around autopsy exist. Awareness-raising amongst religious leaders and community members will be important if these methods become routinely available.
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Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- * E-mail:
| | - Zahira Latif
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Megan Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Monica Lakhanpaul
- Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Community Paediatrics, Whittington Health NHS Trust, London, United Kingdom
| | - Owen J. Arthurs
- Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - John C. Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Lyn S. Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Neil J. Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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15
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Lewis C, Hill M, Arthurs OJ, Hutchinson C, Chitty LS, Sebire NJ. Factors affecting uptake of postmortem examination in the prenatal, perinatal and paediatric setting. BJOG 2017; 125:172-181. [PMID: 28190300 PMCID: PMC5763339 DOI: 10.1111/1471-0528.14600] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
Background Postmortem examination is the single most useful investigation in providing information to parents about why their baby or child died. Despite this, uptake remains well below the recommended 75%. Objective To address the question ‘what are the barriers and motivators to perinatal, prenatal and paediatric PM examination?’ Search strategy Key databases including Pubmed and CINAHL; Cochrane library, websites of relevant patient organisations, hand search of key journals, first and last authors and references. Selection criteria Peer‐reviewed qualitative, quantitative or mixed methods research examining factors affecting uptake or decline of perinatal or paediatric postmortem examination. Data collection and analysis Narrative synthesis; findings were compared across studies to examine interrelations. Main results Seven major themes describing barriers to postmortem uptake were identified: dislike of invasiveness, practicalities of the procedure, organ retention issues, protective parenting, communication and understanding, religion and culture and professional or organisational barriers. Six major themes related to factors which facilitated parental consent were identified: desire for information, contributing to research, coping and well‐being, respectful care, minimally invasive options, and policy and practice. There were a number of themes in the literature that reflected best practice. Conclusion Findings highlight the need for better health professional education and the fact some concerns may be mitigated if less invasive methods of postmortem were routinely available. New consent packages and codes of practice may have a positive impact on perception of examination after death. The landscape is changing; further research is necessary to assess the impact on postmortem uptake rates. Tweetable abstract Systematic review to explore the barriers and motivators to perinatal, prenatal and paediatric postmortem examination. Systematic review to explore the barriers and motivators to perinatal, prenatal and paediatric postmortem examination.
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Affiliation(s)
- C Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK
| | - M Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK.,Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - C Hutchinson
- UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - L S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK
| | - N J Sebire
- UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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16
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Shorey S, André B, Lopez V. The experiences and needs of healthcare professionals facing perinatal death: A scoping review. Int J Nurs Stud 2016; 68:25-39. [PMID: 28063339 DOI: 10.1016/j.ijnurstu.2016.12.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Globally, perinatal death is on a decline. However, its impact on the healthcare profession is huge. The existing literature focuses on examining perinatal death from parents' perspectives and patient death from the perspectives of nurses and a few doctors in critical care, oncology, and neonatology in the West. Due to the unique setting of maternity units where death is not routinely anticipated, as well as distinctive socio-cultural views surrounding death, there is a need to comprehensively review literature examining the impact of perinatal death on the perspectives of healthcare professionals working in maternity units. OBJECTIVES To examine available literature on the needs and experiences of healthcare professionals working in maternity units who have experienced perinatal death. DESIGN A scoping review of published and unpublished data. DATA SOURCES A systematic literature search from 1st January 1996 to 5th August 2016 was made in the following databases: PubMed, CINAHL, Embase, PsycINFO, ScienceDirect, and Web of Science. Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, York Centre for Reviews and Dissemination, Open Grey, ProQuest Dissertation and Theses, and Mednar were reviewed for grey literature. A hand search of the reference lists of the included papers was performed. REVIEW METHODS Based on the pre-set inclusion criteria, 1519 articles were screened for their titles and abstracts. Eighty-five full-text papers were reviewed, resulting in 30 papers included for this review. The data were extracted and cross-checked between the reviewers. Any discrepancy between the authors' views would be discussed with a third reviewer until consensus was reached. Thematic analysis was used to categorise the results into themes. RESULTS Two major themes emerged from the review: the experiences and needs of healthcare professionals. Six subthemes emerged from the experiences of healthcare professionals: 1) psychological impact, 2) physical impact, 3) positive feelings, 4) coping strategies, 5) personal factors influencing the experience, and 6) cultural factors influencing the experience. Three subthemes including 1) social support, 2) training and education, and 3) other needs explained the needs of healthcare professionals. Studies focusing on the experiences and needs of physicians were scarce. CONCLUSIONS Perinatal death has a profound impact on the psychological and physical wellbeing of healthcare professionals. They have unmet needs that need to be addressed. Though they use internal and external resources to combat their stress, institutional support acknowledging their stress and their needs is essential. Culturally-sensitive education and training are needed to provide support to these professionals.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore.
| | - Beate André
- Faculty of Nursing- Centre for Health Promotion Research, NTNU- Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore.
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17
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Ibiebele I, Boyle FM, Horey D, Lourie R, Wilson P, Coory M, Flenady V. Predictors of autopsy following stillbirth in Queensland, Australia: A population-based study. Aust N Z J Obstet Gynaecol 2016; 57:33-39. [DOI: 10.1111/ajo.12563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 10/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ibinabo Ibiebele
- Mater Research Institute-University of Queensland; Brisbane Queensland Australia
- School of Public Health; University of Queensland; Brisbane Queensland Australia
| | - Frances M. Boyle
- Mater Research Institute-University of Queensland; Brisbane Queensland Australia
- School of Public Health; University of Queensland; Brisbane Queensland Australia
| | - Dell Horey
- Mater Research Institute-University of Queensland; Brisbane Queensland Australia
- Department of Public Health; La Trobe University; Melbourne Victoria Australia
| | - Rohan Lourie
- Mater Research Institute-University of Queensland; Brisbane Queensland Australia
- Translational Research Institute; Brisbane Queensland Australia
| | - Patricia Wilson
- Mater Mothers’ Hospital; Mater Health Services; Brisbane Queensland Australia
| | - Michael Coory
- Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Vicki Flenady
- Mater Research Institute-University of Queensland; Brisbane Queensland Australia
- School of Public Health; University of Queensland; Brisbane Queensland Australia
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18
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Thomson G, Downe S. Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North-West England. Midwifery 2016; 40:32-9. [PMID: 27428096 DOI: 10.1016/j.midw.2016.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/19/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE to identify the emotional and support needs of pregnant multigravida women who have experienced adverse responses associated with a previous childbirth experience. SETTING four maternity hospitals in North-West England. DESIGN 100 surveys were distributed at an anomaly scan clinic in each of four maternity hospitals (total n=400). The survey included an adapted version of a Post-Traumatic Stress Disorder Symptom Scale to explore trauma responses at two broad time points: (a) following a previous birth and (b) during the current pregnancy. Participants were also asked about the optimal time to receive support post-birth, and the type and provider of support they had accessed/would have liked to access. Descriptive and inferential statistics were undertaken on the quantitative data. The qualitative data were analysed using a basic thematic approach. PARTICIPANTS multigravida pregnant women aged 18+ years. FINDINGS the overall response rate was 28% (n=112); 43% (n=46) of the women had experienced negative/trauma responses associated with a previous birth, 74% of whom (n=34) continued/re-experienced adverse responses in their current pregnancy. Most commonly reported trauma responses were difficulties in recalling the previous birth(s), avoiding memories associated with it, and the distress associated with these memories when they were recalled. Approximately 54% (n=25) had received some form of support post-birth, and variations in preferred timing of postnatal support provision were reported. Information on available support and opportunities to discuss the birth with a maternity professional were identified most frequently as preferred support options. CONCLUSION AND IMPLICATIONS FOR PRACTICE women's views about what might work should form the basis for effectiveness studies in this area. Among the participants in this study there was evidence of unmet support needs relating to negative or traumatic responses to a previous birth. The range of preferred timing and types of support indicate that flexible needs-based support options should be provided. Further research should assess if these findings are reinforced in a more diverse sample with a higher response rate.
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Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), University of Central Lancashire, Preston, Lancashire PR1 2HE, United Kingdom.
| | - Soo Downe
- Research in Childbirth and Health Unit (ReaCH), University of Central Lancashire, Preston, Lancashire, England PR1 2HE, United Kingdom.
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19
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Judge-Kronis L, Hutchinson J, Sebire N, Arthurs O. Consent for paediatric and perinatal postmortem investigations: Implications of less invasive autopsy. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jofri.2015.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Ellis A, Chebsey C, Storey C, Bradley S, Jackson S, Flenady V, Heazell A, Siassakos D. Systematic review to understand and improve care after stillbirth: a review of parents' and healthcare professionals' experiences. BMC Pregnancy Childbirth 2016; 16:16. [PMID: 26810220 PMCID: PMC4727309 DOI: 10.1186/s12884-016-0806-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/18/2016] [Indexed: 11/16/2022] Open
Abstract
Background 2.7 million babies were stillborn in 2015 worldwide; behind these statistics lie the experiences of bereaved parents. The first Lancet series on stillbirth in 2011 described stillbirth as one of the “most shamefully neglected” areas of public health, recommended improving interaction between families and frontline caregivers and made a plea for increased investment in relevant research. Methods A systematic review of qualitative, quantitative and mixed-method studies researching parents and healthcare professionals experiences of care after stillbirth in high-income westernised countries (Europe, North America, Australia and South Africa) was conducted. The review was designed to inform research, training and improve care for parents who experience stillbirth. Results Four thousand four hundred eighty eight abstracts were identified; 52 studies were eligible for inclusion. Synthesis and quantitative aggregation (meta-summary) was used to extract findings and calculate frequency effect sizes (FES%) for each theme (shown in italics), a measure of the prevalence of that finding in the included studies. Researchers’ areas of interest may influence reporting of findings in the literature and result in higher FES sizes, such as; support memory making (53 %) and fathers have different needs (18 %). Other parental findings were more unexpected; Parents want increased public awareness (20 %) and for stillbirth care to be prioritised (5 %). Parental findings highlighted lessons for staff; prepare parents for vaginal birth (23 %), discuss concerns (13 %), give options & time (20 %), privacy not abandonment (30 %), tailored post-mortem discussions (20 %) and post-natal information (30 %). Parental and staff findings were often related; behaviours and actions of staff have a memorable impact on parents (53 %) whilst staff described emotional, knowledge and system-based barriers to providing effective care (100 %). Parents reported distress being caused by midwives hiding behind ‘doing’ and ritualising guidelines whilst staff described distancing themselves from parents and focusing on tasks as coping strategies. Parents and staff both identified the need for improved training (parents 25 % & staff 57 %); continuity of care (parents 15 % & staff 36 %); supportive systems & structures (parents 50 %); and clear care pathways (parents 5 %). Conclusions Parents’ and healthcare workers’ experiences of stillbirth can inform training, improve the provision of care and highlight areas for future research. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0806-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alison Ellis
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.
| | - Caroline Chebsey
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK
| | | | | | | | - Vicki Flenady
- Mater Research Institute -The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Alexander Heazell
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Dimitrios Siassakos
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.,University of Bristol, School of Social & Community Medicine, Bristol, UK
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21
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Kandasamy Y, Kilcullen M, Watson D. Fetal autopsy and closing the gap. Aust N Z J Obstet Gynaecol 2015; 56:252-4. [DOI: 10.1111/ajo.12421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 09/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Yogavijayan Kandasamy
- Department of Neonatology; The Townsville Hospital; Douglas Queensland Australia
- Mothers and Babies Research Centre; Hunter Medical Research Institute; John Hunter Hospital; The University of Newcastle; Newcastle New South Wales Australia
- College of Medicine and Dentistry; The James Cook University; Townsville Queensland Australia
| | - Meegan Kilcullen
- College of Health Care Sciences; The James Cook University; Townsville Queensland Australia
| | - David Watson
- College of Medicine and Dentistry; The James Cook University; Townsville Queensland Australia
- Department of Obstetrics and Gynaecology; The Townsville Hospital; Douglas Queensland Australia
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22
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Kingdon C, Givens JL, O'Donnell E, Turner M. Seeing and Holding Baby: Systematic Review of Clinical Management and Parental Outcomes After Stillbirth. Birth 2015; 42:206-18. [PMID: 26111120 DOI: 10.1111/birt.12176] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2009 there were an estimated 2.6 million stillbirths worldwide. In the United States, a 2007 systematic review found little consensus about professional behaviors perceived by parents to be most helpful or most distressing. In the United Kingdom, a bereaved parents' organization has highlighted discordance between parental views and clinical guidelines that recommend clinicians do not encourage parents to see and hold their baby. The objective of this review was to identify and synthesize available research reporting parental outcomes relating to seeing and holding. METHODS We undertook a systematic review. We included studies of any design, reporting parental experiences and outcomes. Electronic searches (PubMed and PsychINFO) were conducted in January 2014. Three authors independently screened and assessed the quality of the studies before abstracting data and undertaking thematic analysis. RESULTS We reviewed 741 records and included 23 studies (10 quantitative, 12 qualitative, and 1 mixed-method). Twenty-one studies suggested positive outcomes for parents who saw or held their baby. Increased psychological morbidity was associated with current pregnancy, choice not to see their baby, lack of time with their baby and/or insufficient mementos. Three themes were formulated "positive effects of contact within a traumatic life event," "importance of role of health professionals," and "impact on mothers and fathers: similarities and differences." CONCLUSIONS Stillbirth is a risk factor for increased psychological morbidity. Parents seeing and holding their stillborn baby can be beneficial to their future well-being. Since 2007, there has been a proliferation of studies that challenge clinical guidelines recommending that clinicians do not encourage parental contact.
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Affiliation(s)
- Carol Kingdon
- School of Health, University of Central Lancashire, Preston, Lancashire, UK
| | - Jennifer L Givens
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Emer O'Donnell
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Mark Turner
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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23
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Allahdadian M, Irajpour A, Kazemi A, Kheirabadi G. Social support: An approach to maintaining the health of women who have experienced stillbirth. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:465-70. [PMID: 26257802 PMCID: PMC4525345 DOI: 10.4103/1735-9066.160998] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 12/24/2014] [Indexed: 11/20/2022]
Abstract
Background: Stillbirth is one of the deepest losses that can inflict a broad range of cognitive, mental, spiritual, and physical turmoil. Many researchers believe that the failure to provide the care required by health teams during the hard times is the main determinant of maternal mental health in the future. In other words, social support can significantly improve the mental health outcomes of mothers after stillbirth. This study aimed to explore social support to aid mothers in adaptation after the experience of stillbirth. Materials and Methods: This was a qualitative content analysis in which 15 women who had experienced stillbirth participated. They were selected through purposeful sampling method. Data were gathered by individual interviews recorded on audiotapes, transcribed, and analyzed. Interview transcriptions were coded and then classified. Finally, two main categories and five subcategories emerged. Results: Analysis of participants’ viewpoints and their statements about social support led to the emergence of the two main categories of support from relatives and support from social support systems with two and three subcategories, respectively. Analysis of findings showed that mothers experiencing stillbirth need the support of their spouse and family and friends through sympathizing, in performing everyday activities and to escape loneliness. These women require support from a peer group to exchange experiences and from trauma counseling centers to meet their needs. Conclusions: It seems necessary to revise and modify the care plan in the experience of stillbirth using these results and, of course, to be considered by a panel of experts in order to provide social support to these women. Thus, midwives and healthcare provider can act, based on the development and strengthening of social protection of women experiencing stillbirth, to provide these women with effective and appropriate care.
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Affiliation(s)
- Maryam Allahdadian
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Irajpour
- Department of Critical Care Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Kazemi
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Kheirabadi
- Department of Psychiatry, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Kingdon C, O’Donnell E, Givens J, Turner M. The Role of Healthcare Professionals in Encouraging Parents to See and Hold Their Stillborn Baby: A Meta-Synthesis of Qualitative Studies. PLoS One 2015; 10:e0130059. [PMID: 26154302 PMCID: PMC4495992 DOI: 10.1371/journal.pone.0130059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/15/2015] [Indexed: 11/19/2022] Open
Abstract
Background Globally, during 2013 there were three million recorded stillbirths. Where clinical guidelines exist some recommend that professionals do not encourage parental contact. The guidance is based on quantitative evidence that seeing and holding the baby is not beneficial for everyone, but has been challenged by bereaved parents' organisations. We aim to inform future guideline development through a synthesis of qualitative studies reporting data relevant to the research question; how does the approach of healthcare professionals to seeing and holding the baby following stillbirth impact parents views and experiences? Methods/Findings Using a predetermined search strategy of PubMed and PsychINFO we identified robust qualitative studies reporting bereaved parental views and/or experiences relating to seeing and holding their stillborn baby (final search 24 February, 2014). Eligible studies were English language, reporting parental views, with gestational loss >20weeks. Quality was independently assessed by three authors using a validated tool. We used meta-ethnographic techniques to identify key themes and a line of argument synthesis. We included 12 papers, representing the views of 333 parents (156 mothers, 150 fathers, and 27 couples) from six countries. The final themes were: "[Still]birth: Nature of care is paramount", "Real babies: Perfect beauties, monsters and spectres", and "Opportunity of a lifetime lost." Our line-of-argument synthesis highlights the contrast between all parents need to know their baby, with the time around birth being the only time memories can be made, and the variable ability that parents have to articulate their preferences at that time. Thus, we hypothesised that how health professionals approach contact between parents and their stillborn baby demands a degree of active management. An important limitation of this paper is all included studies originated from high income, westernised countries raising questions about the findings transferability to other cultural contexts. We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation. Conclusions Guidelines could be more specific in their recommendations regarding parental contact. The role of healthcare professionals in encouraging parents to see and hold their stillborn baby is paramount. Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final.
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Affiliation(s)
- Carol Kingdon
- School of Health, University of Central Lancashire, Preston, Lancashire, United Kingdom
- * E-mail:
| | - Emer O’Donnell
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Jennifer Givens
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Mark Turner
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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25
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Meaney S, Gallagher S, Lutomski JE, O'Donoghue K. Parental decision making around perinatal autopsy: a qualitative investigation. Health Expect 2014; 18:3160-71. [PMID: 25376775 DOI: 10.1111/hex.12305] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Decades of decline in uptake rates of perinatal autopsies has limited investigation into the causes and risk factors for stillbirth. AIMS This study aimed to qualitatively explore perinatal autopsy decision-making processes in parents who experienced antepartum and intrapartum stillbirths. MATERIAL AND METHODS A qualitative semi-structured interview format was utilized. The line of questioning centred on how parents came to decide on consenting or declining to have a perinatal autopsy undertaken. Interpretative phenomenological analysis was employed as the analytic strategy. Purposive sampling was used to recruit 10 parents who either consented or declined autopsy from a large tertiary maternity hospital in Cork Ireland, where there were 30 stillbirths in 2011. RESULTS Findings revealed four superordinate themes influencing parents' decision-making which varied with type of stillbirth experienced. Those parents who experienced antepartum stillbirths were more likely to consent; thus, knowing that the child was stillborn prior to delivery rather than on the day of delivery was associated with consent. In fact, these parents had more time for meaning-making; those consenting wanted to rule out self-blame and were fearful about future pregnancies. Parents who declined autopsy wanted to protect their infant from further harm. Interestingly, parents' knowledge and understanding of the autopsy itself were acquired primarily from public discourse. CONCLUSION Parents' decision-making regarding autopsy is profoundly affected by their emotional response to stillbirth; clinicians and other health professionals may play a key role, especially if they can address parental concerns regarding the invasiveness of the autopsy procedure.
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Affiliation(s)
- Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Stephen Gallagher
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Jennifer E Lutomski
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland.,Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Downe S, Schmidt E, Kingdon C, Heazell AEP. Bereaved parents' experience of stillbirth in UK hospitals: a qualitative interview study. BMJ Open 2013; 3:e002237. [PMID: 23418300 PMCID: PMC3586079 DOI: 10.1136/bmjopen-2012-002237] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 12/14/2012] [Accepted: 12/17/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To obtain the views of bereaved parents about their interactions with healthcare staff when their baby died just before or during labour. DESIGN Qualitative in-depth interview study, following an earlier national survey. All interviews took place during 2011, either face-to-face or on the telephone. Data analysis was informed by the constant comparative technique from grounded theory. SETTING Every National Health Service (NHS) region in the UK was represented. PARTICIPANTS Bereaved parents who had completed an e-questionnaire, via the website of Sands (Stillbirth and Neonatal Death Society). Of the 304 survey respondents who gave provisional consent, 29 families were approached to take part, based on maximum variation sampling and data saturation. RESULTS 22 families (n=25) participated. Births took place between 2002 and 2010. Specific practices were identified that were particularly helpful to the parents. Respondents talked about their interactions with hospital staff as having profound effects on their capacity to cope, both during labour and in the longer term. The data generated three key themes: 'enduring and multiple loss': 'making irretrievable moments precious'; and the 'best care possible to the worst imaginable'. The overall synthesis of findings is encapsulated in the meta-theme 'One chance to get it right.' This pertains to the parents and family themselves, clinical and support staff who care for them directly, and the NHS organisations that indirectly provide the resources and governance procedures that may (or may not) foster a caring ethos. CONCLUSIONS Positive memories and outcomes following stillbirth depend as much on genuinely caring staff attitudes and behaviours as on high-quality clinical procedures. All staff who encounter parents in this situation need to see each meeting as their one chance to get it right.
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Affiliation(s)
- Soo Downe
- Research in Childbirth and Health (ReaCH) Group, University of Central Lancashire, Preston, UK
| | - Ellie Schmidt
- Maternal and Fetal Health Research Centre, St Mary's Hospital, Manchester, UK
| | - Carol Kingdon
- Research in Childbirth and Health (ReaCH) Group, University of Central Lancashire, Preston, UK
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