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Freeman MD, Scheinberg Andrews C, Dior UP, Shimony-Kanat S, Bar-Tal Y, Ben-Meir A. Self-reported elevated pain levels: A coping strategy used by women undergoing medical abortion procedures. J Reprod Infant Psychol 2024; 42:481-492. [PMID: 36127865 DOI: 10.1080/02646838.2022.2125940] [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: 05/03/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE Epidural analgesia alleviates pain during normal labour but women who undergo medical abortion procedures using epidural analgesia continue to express high pain levels. To understand this we assessed if patients undergoing medical abortions, treated with epidural analgesia, use their pain for psychological benefits. METHODS This study comprised 105 patients over 13 weeks of gestational age diagnosed with foetal abnormalities after selecting a medical abortion procedure using epidural analgesia. Three questionnaires were handed-out: 1) 'Need for Affect', assessed the motivation to react to emotions; 2) 'Pain-Levels' 3) PANA- 'Positive Affect' (PA), 'Negative Affect' (NA) assessed emotions pre-abortion and post-abortion. RESULTS Patients with a strong Need for Affect and high Pain-Levels expressed a stronger PA post-abortion (b = .69, se = .11, β = .68, p < .001, 95%CI [.48,.90]). Patients with a strong NA pre-abortion and high Pain-Levels expressed a higher NA post-abortion (b = .48, se = .11, β = .53, p < .001, 95%CI [.26, .70]). CONCLUSION Patients with a strong Need for Affect who express a strong PA pre-abortion intensify their pain to fulfill their Need for Affect, which then helps recovery. Patients with a strong NA pre-abortion and high Pain-Levels indicate a less favourable outcome.
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Affiliation(s)
- Martine Denise Freeman
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Caryn Scheinberg Andrews
- Henrietta Szold Hadassah School of Nursing at the Faculty of Medicine, Hebrew University, Jerusalem Israel
| | - Uri Pinchas Dior
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sarit Shimony-Kanat
- Henrietta Szold Hadassah School of Nursing at the Faculty of Medicine, Hebrew University, Jerusalem Israel
| | - Yoram Bar-Tal
- Department of Nursing, Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Assaf Ben-Meir
- Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem Israel
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2
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Goldblatt Hyatt ED, McCoyd JLM. Counseling pregnant people after previous termination of pregnancy for fetal anomaly (TOPFA): the double RAINBOW approach. ANXIETY, STRESS, AND COPING 2023; 36:259-273. [PMID: 35234560 DOI: 10.1080/10615806.2022.2047179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Pregnancy loss is exceptionally common, yet there exist few interventions for clinical providers to assist parents who are expecting again. Perhaps even less prevalent are practice models for parents who have terminated a pregnancy due to fetal anomaly (TOPFA). In this article, we present the "Double Rainbow" acronym, which provides evidence-supported guidance for counseling people experiencing a subsequent pregnancy after TOPFA. DESIGN AND METHODS Using prompts of: Remember; Rehearse & Anticipate; Attach & Internalize; Interrogate decision; Neutralize; Normalize; Bond; Breathe & Observe; Optimize health; Weave and Whole story, we tie intervention techniques to evidence-based treatments and clinical practice examples. RESULTS Filling a gap for guidance for effective intervention with people during subsequent pregnancies after termination of pregnancy due to fetal anomaly, we aim to improve such treatment while also encouraging evaluation of the approach, encouraging evaluation of its use with broader populations. CONCLUSIONS The double RAINBOW approach weaves together evidence-based therapies while also attending to the work of distinguishing past losses and promoting parental attachment and caregiving systems in clients who have terminated a pregnancy due to fetal anomaly.
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3
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Heaney S, Tomlinson M, Aventin Á. Termination of pregnancy for fetal anomaly: a systematic review of the healthcare experiences and needs of parents. BMC Pregnancy Childbirth 2022; 22:441. [PMID: 35619067 PMCID: PMC9137204 DOI: 10.1186/s12884-022-04770-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/16/2022] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Improved technology and advances in clinical testing have resulted in increased detection rates of congenital anomalies during pregnancy, resulting in more parents being confronted with the possibility of terminating a pregnancy for this reason. There is a large body of research on the psychological experience and impact of terminating a pregnancy for fetal anomaly. However, there remains a lack of evidence on the holistic healthcare experience of parents in this situation. To develop a comprehensive understanding of the healthcare experiences and needs of parents, this systematic review sought to summarise and appraise the literature on parents' experiences following a termination of pregnancy for fetal anomaly. REVIEW QUESTION What are the healthcare experiences and needs of parents who undergo a termination of pregnancy following an antenatal diagnosis of a fetal anomaly? METHODS A systematic review was undertaken with searches completed across six multi-disciplinary electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane). Eligible articles were qualitative, quantitative or mixed methods studies, published between January 2010 and August 2021, reporting the results of primary data on the healthcare experiences or healthcare needs in relation to termination of pregnancy for fetal anomaly for either, or both parents. Findings were synthesised using Thematic Analysis. RESULTS A total of 30 articles were selected for inclusion in this review of which 24 were qualitative, five quantitative and one mixed-methods. Five overarching themes emerged from the synthesis of findings: (1) Contextual impact on access to and perception of care, (2) Organisation of care, (3) Information to inform decision making, (4) Compassionate care, and (5) Partner experience. CONCLUSION Compassionate healthcare professionals who provide non-judgemental and sensitive care can impact positively on parents' satisfaction with the care they receive. A well organised and co-ordinated healthcare system is needed to provide an effective and high-quality service. TRIAL REGISTRATION PROSPERO registration number: CRD42020175970 .
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Affiliation(s)
- Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland.
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland
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Tewani KG, Jayagobi PA, Chandran S, Anand AJ, Thia EWH, Bhatia A, Bujal R, Khoo PC, Quek BH, Tagore S, Chua MC. Perinatal Palliative Care Service: Developing a Comprehensive Care Package for Vulnerable Babies with Life Limiting Fetal Conditions. J Palliat Care 2021; 37:471-475. [PMID: 34636715 DOI: 10.1177/08258597211046735] [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: 11/16/2022]
Abstract
Background: Perinatal Palliative Care provides comprehensive and holistic care for expectant and new parents, who receive a diagnosis of life-limiting fetal condition and opt to continue pregnancy and care for their newborn infant. Aim: To develop a service providing individually tailored holistic care during pregnancy, birth, postnatal and bereavement period. Methods: Following a baseline survey of neonatologists and discussions with key stakeholders we launched the Perinatal Palliative service at the KK Women's and Children's hospital, Singapore in January 2017. The multidisciplinary team, led by a Palliative care specialist comprised of Obstetricians, Neonatologists, nurses and medical social workers. The Birth defect clinic referred parents with antenatally diagnosed 'Lethal' fetal conditions. The team checked the understanding and the decision making process of parents and initiated and finalized advance care plans. The service also embraced deserving postnatal referrals upon request. Results: A total of 41 cases were seen from January 2017 to December 2019. Of these, 26/41(63%) were referred antenatally and had completed advance care plans. 18/41 (44%) died during or shortly after birth and 10/41(24%) continue to survive and are supported by the community palliative team. During this time a workflow was formulated and modified based on parent and team feedback. Conclusion: Awareness of the service has increased over the years and a clear workflow has been formulated. Advance care plans are prepared and documented before birth so as to enable service teams on board to provide well timed pertinent care. Feedbacks from parents about this service were positive.
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Affiliation(s)
- Komal G Tewani
- Perinatal Palliative (PeriPal) Care, KK Women's and Children's Hospital, Singapore, Singapore.,Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore
| | - Pooja A Jayagobi
- Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore.,Academic Clinical Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Suresh Chandran
- Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore.,Academic Clinical Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Amudha J Anand
- Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore.,Academic Clinical Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Edwin W H Thia
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Anju Bhatia
- Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore.,Academic Clinical Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Rahimah Bujal
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Poh Choo Khoo
- Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore.,Academic Clinical Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Bin Huey Quek
- Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore.,Academic Clinical Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Shephali Tagore
- Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Mei Chien Chua
- Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore.,Academic Clinical Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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5
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Obst KL, Due C, Oxlad M, Middleton P. Men's experiences and need for targeted support after termination of pregnancy for foetal anomaly: A qualitative study. J Clin Nurs 2021; 30:2718-2731. [PMID: 33899276 DOI: 10.1111/jocn.15786] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore men's experiences of termination of pregnancy for life-limiting foetal anomaly, including how healthcare providers, systems and policies can best support men and their families. BACKGROUND While there is a sizable body of research and recommendations relating to women's experiences of grief and support needs following a termination of pregnancy for foetal anomaly, very few studies specifically examine men's experiences. METHODS Semi-structured interviews were completed with ten Australian men who had experienced termination of pregnancy for life-limiting foetal anomalies with a female partner between six months and 11 years ago. Interviews were completed over the telephone, and data were analysed using thematic analysis. COREQ guidelines were followed. RESULTS Thematic analysis resulted in the identification of three over-arching themes, each with two sub-themes. First, participants described the decision to terminate their pregnancy as The most difficult choice, with two sub-themes detailing 'Challenges of decision-making' and 'Stigma surrounding TOPFA'. Second, participants described that they were Neither patient, nor visitor in the hospital setting, with sub-themes 'Where do men fit?' and 'Dual need to support and be supported'. Finally, Meet me where I am described men's need for specific supports, including the sub-themes 'Contact men directly' and 'Tailor support and services'. CONCLUSIONS Findings indicated that termination of pregnancy for life-limiting foetal anomaly (TOPFA) is an extremely difficult experience for men, characterised by challenges in decision-making and perceived stigma. Men felt overlooked by current services and indicated that they need specific support to assist with their grief. Expansion of existing infrastructure and future research should acknowledge the central role of fathers and support them in addressing their grief following TOPFA. RELEVANCE TO CLINICAL PRACTICE Nursing/midwifery professionals are well situated to provide men with tailored information and to promote genuine inclusion, acknowledgement of their grief, and facilitate referrals to community supports.
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Affiliation(s)
- Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Melissa Oxlad
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Philippa Middleton
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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6
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Obst KL, Oxlad M, Due C, Middleton P. Factors contributing to men's grief following pregnancy loss and neonatal death: further development of an emerging model in an Australian sample. BMC Pregnancy Childbirth 2021; 21:29. [PMID: 33413199 PMCID: PMC7792062 DOI: 10.1186/s12884-020-03514-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background Historically, men’s experiences of grief following pregnancy loss and neonatal death have been under-explored in comparison to women. However, investigating men’s perspectives is important, given potential gendered differences concerning grief styles, help-seeking and service access. Few studies have comprehensively examined the various individual, interpersonal, community and system/policy-level factors which may contribute to the intensity of grief in bereaved parents, particularly for men. Methods Men (N = 228) aged at least 18 years whose partner had experienced an ectopic pregnancy, miscarriage, stillbirth, termination of pregnancy for foetal anomaly, or neonatal death within the last 20 years responded to an online survey exploring their experiences of grief. Multiple linear regression analyses were used to examine the factors associated with men’s grief intensity and style. Results Men experienced significant grief across all loss types, with the average score sitting above the minimum cut-off considered to be a high degree of grief. Men’s total grief scores were associated with loss history, marital satisfaction, availability of social support, acknowledgement of their grief from family/friends, time spent bonding with the baby during pregnancy, and feeling as though their role of ‘supporter’ conflicted with their ability to process grief. Factors contributing to grief also differed depending on grief style. Intuitive (emotion-focused) grief was associated with support received from healthcare professionals. Instrumental (activity-focused) grief was associated with time and quality of attachment to the baby during pregnancy, availability of social support, acknowledgement of men’s grief from their female partner, supporter role interfering with their grief, and tendencies toward self-reliance. Conclusions Following pregnancy loss and neonatal death, men can experience high levels of grief, requiring acknowledgement and validation from all healthcare professionals, family/friends, community networks and workplaces. Addressing male-specific needs, such as balancing a desire to both support and be supported, requires tailored information and support. Strategies to support men should consider grief styles and draw upon father-inclusive practice recommendations. Further research is required to explore the underlying causal mechanisms of associations found. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03514-6.
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Affiliation(s)
- Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, South Australia.
| | - Melissa Oxlad
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Philippa Middleton
- South Australian Health and Medical Research Institute, Adelaide, South Australia
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7
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Lafarge C, Rosman S, Ville I. Pregnancy termination for fetal abnormality: Ambivalence at the heart of women's experience. WOMENS STUDIES INTERNATIONAL FORUM 2019. [DOI: 10.1016/j.wsif.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Anencephaly; the maternal experience of continuing with the pregnancy. Incompatible with life but not with love. Midwifery 2018; 71:12-18. [PMID: 30640134 DOI: 10.1016/j.midw.2018.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 12/04/2018] [Accepted: 12/22/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE As advances in prenatal diagnosis increasingly enable detection of life-limiting conditions, end-of-life care may start before birth. Termination of these pregnancies may have been default management, but in the Republic of Ireland, where termination is not a legal option, skilled experience in caring for mothers who continue their pregnancies has developed. This study examines the lived experience of four such mothers. METHOD A qualitative study was designed using interpretive phenomenological analysis, which examined the maternal experience of continuing pregnancy with a prenatal diagnosis of anencephaly. Four mothers participated in semi-structured interviews on their experience of pregnancy and delivery of a baby with anencephaly. RESULTS A profoundly emotional journey represented an adaptive grieving process, which culminated in rich experiences of transformative growth for all the parents. The parents' relationship with their caregivers facilitated this process and the development of a meaningful parenting relationship with their babies. This positive finding coexists alongside a parallel experience of ongoing deep sense of loss and sadness. CONCLUSION Perinatal palliative care for those with a prenatal lethal diagnosis is a positive life experience for some mothers. The role of relationship with healthcare professionals is vital to the process and consideration must be given to a comprehensive multi-disciplinary team approach.
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9
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Hanschmidt F, Treml J, Klingner J, Stepan H, Kersting A. Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression. Arch Womens Ment Health 2018; 21:391-399. [PMID: 29288285 DOI: 10.1007/s00737-017-0807-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/18/2017] [Indexed: 11/24/2022]
Abstract
Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women's psychological reactions. This study examined the influence of perceived and internalized stigma on women's long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women.
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Affiliation(s)
- Franz Hanschmidt
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Julia Treml
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Johanna Klingner
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
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10
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Maniatelli E, Zervas Y, Halvatsiotis P, Tsartsara E, Tzavara C, Briana DD, Salakos N. Translation and validation of the Perinatal Grief Scale in a sample of Greek women with perinatal loss during the 1st and 2nd trimester of pregnancy. J Matern Fetal Neonatal Med 2017; 31:47-52. [DOI: 10.1080/14767058.2016.1274303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elissavet Maniatelli
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - Yiannis Zervas
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Panagiotis Halvatsiotis
- 2nd Department of Internal Medicine-Propaedeutic and Diabetes Center, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Eirini Tsartsara
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Chara Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Centre for Health Services Research, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina D. Briana
- 1st Department of Pediatrics, Neonatal Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Salakos
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
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11
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Lafarge C, Mitchell K, Fox P. Termination of pregnancy for fetal abnormality: a meta-ethnography of women’s experiences. REPRODUCTIVE HEALTH MATTERS 2014; 22:191-201. [DOI: 10.1016/s0968-8080(14)44799-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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12
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Nazaré B, Fonseca A, Canavarro MC. Adaptive and maladaptive grief responses following TOPFA: actor and partner effects of coping strategies. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2013.806789] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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