Perinatal Loss: The Impact on Maternal Mental Health

Termination of pregnancy due to fetal anomaly: A qualitative study from Turkey on women's experiences

BACKGROUND

Termination of pregnancy due to fetal anomaly is an unexpected traumatic event for women. It can cause serious complications that can negatively affect both the physical and psychological health of women.

AIM

This study aims to examine the experiences of women who underwent medical termination for fetal anomaly in the second trimester.

METHODS

The study included 12 women whose pregnancies were terminated due to fetal anomaly. Data were collected through in-depth interviews until data sufficiency was reached. Thematic analysis method was used to analyze the data. This study was conducted using an inductive qualitative design. The women's statements were examined and double-coded. By examining the codes, main themes were created after sub-themes.

RESULTS

Women's experiences were analyzed in five themes: difficulty in decision-making (1), emotional impact (2), stigmatization (3), dilemma between hope and anxiety (4), and post-termination care and support needs (5). Participants stated that they experienced many emotions such as indecision, sadness, helplessness, guilt, and remorse during the medical termination process. Hope, anxiety, fear, social pressure and support needs were also frequently experienced in this process.

CONCLUSION

Termination of pregnancy in the second trimester due to fetal anomaly caused significant psychological symptoms. In order to prevent long-term health complications, it will be important for health professionals to provide interventions designed to meet the demands of women diagnosed with fetal anomaly.

"The Dark Farewell to the Light of Life": A Qualitative Study About Prenatal Loss

AIM

This study was conducted to determine the experiences of women who encountered loss in the prenatal period.

METHOD

This study was a qualitative study conducted using the phenomenological method and was conducted according to the guidelines of the COREQ checklist. A total of 11 women who were experienced loss in the early prenatal period were interviewed. The data were analyzed using the content analysis.

RESULTS

Three main themes and eight sub-themes emerged. The themes were light of life (bubble of happiness, journey), dark farewell (silent scream inside, unfinished tale: motherhood, loneliness, family approach) and obscurity (uncertainty about the future, need for support). Women expressed that the loss process had negative effects on their mental health and that they needed help.

CONCLUSION

Pregnancy illuminates women's lives, while prenatal loss involves intense and various negative emotions, and women need support in many ways. These results show that women who experienced loss in the prenatal period should be allowed to express their feelings, thoughts and experiences, and the risks in terms of mental health should be reduced by supporting them during the loss and mourning process.

Psychosocial intervention programme based on the needs of women undergoing termination of pregnancy for foetal anomalies: A modified Delphi study

AIM

To construct a psychosocial intervention programme for women diagnosed with foetal anomalies based on their needs in China.

DESIGN

A three round-modified Delphi survey from September to November 2020.

METHODS

In Round 1, based on literature review and qualitative interviews, a face-to-face meeting with eight taskforce members was conducted to generate the initial intervention indicators. In Round 2 and 3, 15 experts and three stakeholders (women undergoing termination of pregnancy for foetal anomalies) were invited by email to evaluate the importance of the indicators and built the final psychosocial intervention programme.

RESULTS

The response rate for both two rounds is 100%. The experts' authority coefficient was 0.86. The Kendall W value of the two rounds ranged between 0.191 and 0.339. A needs-based psychosocial intervention programme was established, including four periods (denial, confirmation, decision-making and recovery), three needs-based supports (information, social and acceptance commitment therapy) and 27 intervention indicators. The mean value of the importance of each index was 4.00-5.00. Further research is required to evaluate whether this programme is realistic and effective for the target audiences.

Spanish adaptation of the Stillbirth Stigma Scale (SSS)

The death of a baby in the perinatal period is considered a disenfranchized grief that can be a source of significant symptoms of guilt, shame, and stigma. There is a lack of validated instruments for assessing the stigma associated with perinatal grief. The aim of this study was to examine the psychometric properties (factor structure, reliability, and validity) of the Spanish version of the Stillbirth Stigma Scale (SSS) in parents who have experienced a perinatal loss. A total of 291 participants (mostly mothers) completed an online questionnaire that included the SSS and other measures. The best-fitting factor structure was a second-order model with four dimensions and adequate reliability values. In terms of validity, we found statistically significant relationships between the SSS scores and the variables of self-esteem, complicated grief, event centrality, depression, and anxiety. In conclusion, the Spanish adaptation of the SSS is deemed to have adequate psychometric properties.

An Overview for the General Psychiatrist Evaluating Patients With Obstetric and Neonatal Complications and Perinatal Loss

When neonatal and obstetrical complications occur, the identification and management of mood and anxiety disorders become complex with an ever-expanding array of psychiatric needs that include the management of grief- and trauma-related disorders. With high rates of maternal morbidity and mortality in the United States and laws in many states restricting reproductive health access, psychiatrists must be proficient in managing psychiatric sequelae in this context. High-risk groups for peripartum mood and anxiety disorders, posttraumatic stress disorder, and complicated grief include those with neonatal intensive care unit (NICU) stays and those who have experienced infertility and recurrent pregnancy loss. Groups who have been historically marginalized by the medical system (e.g., Black, Indigenous, people of color) and those from LGBTQ+ communities are at similarly high risk, and more interventions are needed to support these groups. Strategies emphasizing trauma-informed care, psychotherapeutic approaches, and using patient-centered language are recommended.

Effect of adverse perinatal outcomes on postpartum maternal mental health in low-income and middle-income countries: a protocol for systematic review

INTRODUCTION

More than three-fourths of adverse perinatal outcomes (preterm, small for gestational age, low birth weight, congenital anomalies, stillbirth and neonatal death) occur in low-income and middle-income countries. These adverse perinatal outcomes can have both short-term and long-term consequences on maternal mental health. Even though there are few empirical studies on the effect of perinatal loss on maternal mental illness, comprehensive information on the impact of adverse perinatal outcomes in resource-limited settings is scarce. Therefore, we aim to systematically review and synthesise evidence on the effect of adverse perinatal outcomes on maternal mental health.

METHODS AND ANALYSIS

The primary outcome of our review will be postpartum maternal mental illness (anxiety, depression, post-traumatic stress disorder and postpartum psychosis) following adverse perinatal outcomes. All peer-reviewed primary studies published in English will be retrieved from databases: PubMed, MEDLINE, CINAHL Ultimate (EBSCO), PsycINFO, Embase, Scopus and Global Health through the three main searching terms-adverse perinatal outcomes, maternal mental illness and settings, with a variant of subject headings and keywords. We will follow the Joanna Briggs Institute critical appraisal checklist to assess the quality of the studies we are including. The review findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Estimate-based meta-analysis will be performed. We will assess heterogeneity between studies using the I2 statistics and publication bias will be checked using funnel plots and Egger's test. A subgroup analysis will be conducted to explore potential sources of heterogeneity (if available). Finally, the certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach.

ETHICS AND DISSEMINATION

Since this systematic review does not involve human participants, ethical approval is not required. The review will be submitted for publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023405980.

Impact of contact with the baby following stillbirth on parental mental health and well-being: A systematic review and meta-analysis

AIM

This study aims to identify and synthesize available research reporting parental mental health outcomes related to contact with a stillborn baby.

BACKGROUND

Stillbirth is devastating events for parents. The effects of contact with the stillborn baby on parental mental health are uncertain.

METHODS

This was a systematic review and meta-analysis carried out by searching six international electronic databases including PubMed, EMBASE, Cochrane, Web of Science, PsycINFO and CNKI databases from inception to 15 January 2023. Review Manager software was used for data analysis.

RESULTS

Ten studies were included (n = 3974). Contact with a stillborn baby increased the risks of anxiety, depression and post-traumatic stress disorder in the short term and increased the risks of anxiety and post-traumatic stress disorder in the long term. Parents who had contact with a stillborn baby were more satisfied with their decision. Subgroup analysis showed that seeing a stillborn baby had no significant effect on anxiety or depression, but holding a stillborn baby increased the risks of anxiety.

CONCLUSIONS

Caregivers should respect the parents' decision on whether to have contact with the stillborn baby and provide parents with continuous information, emotional and behavioural support after they have contact with stillborn babies.

Psychological distress in subsequent pregnancy among women with a history of pregnancy loss: A latent profile analysis

BACKGROUND

Women who have undergone pregnancy loss can experience a range of psychological distress during subsequent pregnancies; however, the outcomes may vary based on individual circumstances.

OBJECTIVE

To explore the potential patterns of psychological distress for pregnant women with a history of pregnancy loss, and to investigate the impact of factors related to pregnancy loss on these patterns.

METHODS

From October 2022 to August 2023, the participants were recruited from four medical centers in Guangdong Province, China. They completed a questionnaire survey comprising sociodemographic and obstetric characteristics, the Perceived Stress Scale-4 (PSS-4), the Impact of Event Scale-Revised (IES-R), the Pregnancy-related Anxiety Questionnaire-Revised 2 (PRAQ-R2), and the Patient Health Questionnaire-9 (PHQ-9). Latent profile analysis was used to determine optimal patterns of psychological distress. The logistic regression was conducted to assess the associations between the number of pregnancy loss, types of pregnancy loss, inter-pregnancy interval, and distinct psychological distress patterns.

RESULTS

A total of 446 pregnant women with a history of pregnancy loss were included for formal analysis. Three distinct profiles were identified, namely the "mild psychological distress" (34.1 %), "moderate psychological distress" (57.8 %), and "severe psychological distress" (8.1 %). Recurrent pregnancy loss was associated with increased risks of both moderate (adjusted odds ratio [aOR] 2.45, 95 % confidence interval [CI]: 1.42-4.24; P = 0.001) and severe psychological distress (aOR 2.93, 95 %CI: 1.25-6.83; P = 0.013). Furthermore, compared to women who conceived after 6 months of pregnancy loss, those who conceived within 6 months of pregnancy loss were more likely to be categorized into the group of moderate psychological distress (aOR 2.00, 95 % CI: 1.21-3.30; P = 0.007).

CONCLUSIONS

Approximately two-thirds of pregnant women with a history of pregnancy loss exhibit moderate to severe psychological distress. Such individuals could benefit from early screening and targeted psychological interventions, particularly those who have encountered recurrent pregnancy loss and those who conceive shortly after a pregnancy loss.

Interpretative Phenomenology of Grief following Reproductive Loss: A Narrative Review and Considerations on Improving Support

The loss of pregnancy through miscarriage or stillbirth is typically an unexpected and highly distressing event for parents. While death in any form may be overwhelming to those bereaved, pregnancy and newborn loss are unique in several ways because they involve the added loss of parental identity and the idealized baby and family. In this study, the authors performed a narrative review of the literature regarding the phenomenon of grief following reproductive loss in bereaved parents, focusing on heteronormative mothers and fathers and on nontraditional families. One of the main highlighted aspects is the disenfranchisement of grief, which refers to a loss that is not or cannot be acknowledged, publicly mourned, or socially supported. This feeling is elicited by family, society, and healthcare providers. Although the literature has consistently documented the negative impact of this type of experience on parents and families, it is still largely unrecognized by healthcare providers. As most studies demonstrate, there are significant gaps in the psychosocial components of miscarriage and stillbirth care, including a lack of clarity in communication about the loss and subsequent steps, a lack of empathy, an invalidation of grief, and a failure to attend to emotional needs. Since healthcare providers are most often the first point of contact as they experience the loss, it is imperative to act so that patients' needs are more adequately met. To this purpose, the authors propose a set of measures aimed at improving the quality of care and support.

Women's desires for mental health support following a pregnancy loss, termination of pregnancy for medical reasons, or abortion: A report from the STRONG Women Study

OBJECTIVE

We report on women's mental health care desires following a miscarriage, medical termination, or abortion.

METHOD

689 women completed a questionnaire on reproductive history, health care following miscarriage/medical termination/abortion, and current mental health. Descriptive statistics and logistic regression analyses examined: miscarriage/termination/abortion incidence, desires for mental health support following miscarriages/terminations/abortions, and current mental health.

RESULTS

Of 365 women with a pregnancy history, 37% reported ≥1 miscarriage, 9% ≥1 medical termination, 16% ≥1 abortion, and 3% endorsed all three. Current mental health did not differ between women with a history of miscarriage/termination/abortion and those with only live births (p = 0.82). Following miscarriage, 68% of women discussed options for the medical management of pregnancy loss with their provider, 32% discussed grief/loss, and 25% received mental health care recommendations. Engagement in mental health services was reported by 16% of women with a history of miscarriage, 38% after medical termination, and 19% following an abortion. Of women who became pregnant after their most recent miscarriage/termination/abortion and did not receive mental health care, 55% wished they had received services during the subsequent pregnancy.

CONCLUSIONS

Women desire mental health care after miscarriages, medical terminations, or abortions, warranting improved access to mental health care for these individuals.

Effectiveness of mental health website intervention on stress and depression for women with recurrent miscarriage: A randomized controlled trial

We aimed to investigate the effect of a mental health website intervention on perceived stress, depression, sleep quality, and social support in women with recurrent miscarriage (RM). Performing a randomized controlled trial, the participants in the experimental group (n = 31) received a 12-week mental health website intervention; the participants in the control group (n = 31) received RM standard medical care only. The paired t-tests results for the mean posttest scores for depression (p = .023) and perceived stress (p = .041) in the experimental group showed a significant decrease, but did not in the control group.

Experiences of obstetric nurses and midwives receiving a perinatal bereavement care training programme: A qualitative study

Aim

To explore obstetric nurses and midwifery professionals’ experiences with the Perinatal Bereavement Care Training Programme (PBCTP) after implementation.

Design

A qualitative descriptive design was used.

Method

This qualitative study was conducted at a tertiary level maternity hospital in China. The PBCTP was implemented at Women’s Hospital School of Medicine, Zhejiang University from March to May 2022. A total of 127 nurses and 44 midwives were invited to participate in the training. Obstetric nurses and midwives studied a 5-module training programme comprised of eight online theoretical courses and submitted a reflective journal after each session. Semi-structured interviews were conducted with 12 obstetric nurses and four midwives from May to July 2022 as a post-intervention evaluation. Thematic analysis was used in data analysis.

Findings

A total of 16 participants in this study ranged in age from 23 to 40 years [mean age (SD), 30 (4) years]. Six main themes within participants’ experiences of PBCTP intervention were identified: participants’ aims of undertaking the training; personal growth and practice changes after training; the most valuable training content; suggestions for training improvement; directions for practice improvement; influencing factors of practice optimization.

Conclusion

Nursing and midwifery professionals described the PBCTP as satisfying their learning and skills enhancement needs and supporting positive changes in their care providing for bereaved families. The optimized training programme should be widely applied in the future. More efforts from the hospitals, managers, obstetric nurses, and midwives are needed to jointly contribute to forming a uniform care pathway and promoting a supportive perinatal bereavement care practice.

Improvement of stress adaptation and insulin resistance in women with GDM by WeChat group management during novel coronavirus pneumonia

Aim

To evaluate the improvement of glycemic control and stress adaptation in patients with GDM by mobile phone WeChat management during novel coronavirus pneumonia.

Methods

In this study, 75 women with GDM were included, of whom 35 were included in mobile WeChat group management as the GDM-M group and 40 as the GDM group.

Results

After mobile WeChat group management for 4 weeks, E and NE were lower. MDA was lower, and SOD was higher. HOMA-IR was lower. E, NE, and cortisol were related to HOMA-IR positively, MDA was positively related to HOMA-IR, and SOD was negatively related to HOMA-IR. E and cortisol were positively related to MDA but negatively related to SOD.

Conclusion

The stress adaptation disorder and insulin resistance in patients with GDM who have completed mobile WeChat group management can be improved during novel coronavirus pneumonia. Mobile WeChat management played a positive role in improving the insulin resistance of women with GDM under special circumstances, which may reduce the risk of maternal and fetal complications.

The intervention effect of mental health knowledge integrated into ideological and political teaching on college students’ employment and entrepreneurship mentality

In order to analyze the intervention effect of integrating mental health knowledge into ideological and political teaching on college students’ employment and entrepreneurship mentality, this paper proposes a study to predict the effect of integrated intervention. This research mainly investigates the ideological and psychological conditions of college students from divorced families through questionnaires, compares and analyzes the classification and statistical results of the survey data between groups and within groups, and analyzes the reasons for the ideological and psychological problems of college students. The experimental results show that 30% of college students from divorced families and college students from non-divorced families responded that they do not feel comfortable in places with many people, and the difference between the groups is not significant. Regarding the concept of entrepreneurship, 64.63% of college students from divorced families in urban areas believe that entrepreneurship is a form of learning and should be encouraged. 63.27% of college students from divorced families in rural areas believe that learning should be the first priority and that a business should not be started. 20.41% of college students from divorced families in rural areas and 25.61% of college students from divorced families in urban areas believe that because entrepreneurship provides economic income, it can reduce the burden on families, but the difference is not obvious. In short, this study can provide reference for the ideological and psychological status of college students from divorced families.

Factors influencing parental posttraumatic stress disorder in cases of fetal abnormality requiring pregnancy termination in China

PURPOSE

To estimate the prevalence of posttraumatic stress disorder (PTSD) among parents in cases of fetal abnormalities and associated factors.

DESIGN AND METHODS

A cross-sectional study. The study sample comprised 169 couples who experienced fetal abnormalities.

FINDINGS

We observed a high prevalence of PTSD. Fathers had similar levels of PTSD to those of mothers. Social support was an important protective factor against parental PTSD. In addition, a negative psychological reaction to the loss of a child in either the father or the mother affects the other spouse.

PRACTICE IMPLICATIONS

This study emphasizes recognizing the importance of social support and of psychological interactions between mothers and fathers in PTSD intervention for parents.

A Qualitative Exploration of Stressors: Voices of African American Women who have Experienced Each Type of Fetal/Infant Loss: Miscarriage, Stillbirth, and Infant Mortality

Historically, African American women have experienced racial disparities in miscarriage, stillbirth, and infant mortality rates. Yet, little attention has been given to stressors that African American women may experience prior to, during, and after experiencing fetal/infant loss. This study provided an opportunity for African American women to describe their lived experiences of stressors prior to, during, and after experiencing each type of fetal/infant loss. Semi-structured interviews were conducted with seven African American women. Each participant experienced miscarriage, stillbirth, and infant mortality and were 18 years of age or older. Recruitment occurred in 2019 in a county in Northeast Ohio and data were analyzed using descriptive coding and thematic analysis. Four themes identified how these African American women navigated stressors prior to, during, and after experiencing each type of fetal/infant loss: (a) social support, (b) grief, (c) internal conflict, and (d) pregnancy, delivery, and death of child. Our findings expand the literature by being an innovative study may bring awareness and influence programs that assist African American women during their experience with fetal/infant loss.

Comparing posttraumatic growth in mothers after stillbirth or early miscarriage

The possibility of posttraumatic growth in the aftermath of pregnancy loss has received limited attention to date. This study investigated posttraumatic growth in mothers following stillbirth compared to early miscarriage. It was hypothesised that mothers following stillbirth will demonstrate more posttraumatic growth, challenge to assumptive beliefs, and disclosure than mothers following early miscarriage. The study also sought to understand how theoretically-derived variables of the Model of Growth in Grief (challenge to assumptive beliefs and disclosure) explained unique variance in posttraumatic growth when key factors were controlled for. One-hundred and twenty women who had experienced a stillbirth (N = 57) or early miscarriage (N = 63) within the last two to six years completed validated questionnaires in an online survey relating to posttraumatic growth and key variables relevant to emotional adjustment post-bereavement. Participants who had experienced a stillbirth demonstrated significantly higher levels of posttraumatic growth, posttraumatic stress symptoms, perinatal grief, disclosure, challenge to assumptive beliefs and rumination than participants who had experienced an early miscarriage (Cohen’s d ranged .38-.94). In a hierarchical stepwise regression analysis, challenge to assumptive beliefs alone predicted 17.5% of the variance in posttraumatic growth. Intrusive and deliberate rumination predicted an additional 5.5% of variance, with urge to talk, reluctance to talk, and actual self-disclosure predicting a further 15.3%. A final model including these variables explained 47.9% of the variance in posttraumatic growth. Interventions targeting challenge to assumptive beliefs, disclosure, and rumination are likely to be clinically useful to promote psychological adjustment in mothers who have experienced stillbirth and early miscarriage.

Application of Color Ultrasound in the Diagnosis of Gynecological Endocrine Disorders and Study of Ultrasonic Image Characteristics

In order to study gynecological endocrine disorders, color ultrasound and image examination were used for in-depth study. After examining the clinical significance, research methods, strengthening treatment measures, and adjusting physical and mental health, the research and examination of endocrine disorders under ultrasound and ultrasound images are successfully analyzed. Endocrine is like a woman’s umbrella. When it is in harmony with the body, it will make women as beautiful as flowers. Once it becomes an endocrine disorder, it will cause a lot of trouble to women. According to the statistics of a magazine, the incidence of facial chloasma in young and middle-aged women is 28.2%; breast cancer in women over 30 years old has a breast mass of 38.8–49.3%, of which 1–2% may be converted to breast cancer. For the treatment of patients with gynecological endocrine disorders, we mainly use simple western medicine, but the curative effect is not ideal. The rehabilitation speed of patients is relatively slow, which has certain treatment limitations. After the ultrasound research on endocrine disorders, the ultrasound can not only determine the female endocrine function but also diagnose diseases related to endocrine disorders, which basically meets the general understanding of clinicians on the screening of endocrine disorders and physiological functions.

Family-building and parenting considerations for people with cystic fibrosis

As people with cystic fibrosis (CF) live longer and healthier lives, increasing numbers are considering the full range of reproductive options for their futures, including parenthood, pregnancy, or pregnancy prevention. As the face of CF changes, the CF care model must adapt to meet the reproductive health needs of both parents and nonparents with CF. This article summarizes the reproductive goals and family-building concerns faced by people with CF, including fertility, pregnancy, and alternative paths to parenthood, the impact of parenthood on mental and physical health, and important future research.

A Multidisciplinary, Family-Oriented Approach to Caring for Parents After Miscarriage: The Integrated Behavioral Health Model of Care

Miscarriage is increasingly gaining recognition, both in scientific literature and media outlets, as a loss that has significant and lasting effects on parents, though often disenfranchised and overlooked by both personal support networks and healthcare providers. For both men and women, miscarriage can usher in intense grief, despair, and difficulty coping, and for women in particular, there is evidence of increased prevalence of depression, anxiety, and post-traumatic stress. Additionally, miscarriage can contribute to decreased relationship satisfaction and increased risk of separation, all while stigma and disenfranchisement create a sense of isolation. Despite this increased need for support, research indicates that many parents experience their healthcare providers as dismissive of the significance of the loss and as primarily focusing only on the physical elements of care. Research exploring the barriers to providers engaging in more biopsychosocial-oriented care has identified time constraints, lack of resources, lack of training in addressing loss, and compassion fatigue as key areas for intervention. This paper will review the biopsychosocial elements of miscarriage and discuss a multidisciplinary, family-oriented approach that can be implemented in healthcare settings to ensure a high quality and holistic level of care for individuals, couples, and families experiencing pregnancy loss.

Obstetric Outcomes in the Surviving Fetus after Intrauterine Fetal Death in Bichorionic Twin Gestations

Twin pregnancies are high-risk gestations that increase the odds of obstetrical complications. They can also present specific and rare complications such as single intrauterine fetal death (IUFD). This complication has been extensively studied in monochorionic but not in bichorionic gestations. Today, the repercussions of IUFD may have on the surviving fetus, mother and bichorionic pregnancy are not known. Our objective was to study materno-obstetrical, fetal, and immediate delivery neonatal complications in bichorionic twin gestations with single IUFD compared to those with both fetuses alive. A retrospective and observational case-control study was performed in bichorionic biamniotic twin pregnancies, 22 complicated with single IUFD after 14 weeks (cases; IUFD group) and 51 with both fetuses alive (controls; non-IUFD group, from Obstetrics Service of La Paz Hospital (Madrid, Spain). The data were collected from obstetrical records. No significant differences were found in the rates of gestational diabetes, gestational hypertension, preeclampsia, neonatal complications, and prematurity between IUFD and non-IUFD groups. Statistical differences were found for the incidence of intrauterine growth restriction in the surviving fetus compared to first fetus of pregnancy with both fetuses alive (22.7% versus 2.0%, respectively; p-value = 0.012). There were no differences compared to second fetus (11.8%; p-value = 0.23). There was a high C-section rate in both groups (IUFD = 63.6%, non-IUFD = 64.7%; p-value = 0.19). In conclusion, single IUFD in bichorionic biamniotic twin gestations is a rare complication that should be closely monitored. It is essential that these gestations be attended by a clinical multidisciplinary team.