1
|
Garabedian C, Sibiude J, Anselem O, Attie-Bittach T, Bertholdt C, Blanc J, Dap M, de Mézerac I, Fischer C, Girault A, Guerby P, Le Gouez A, Madar H, Quibel T, Tardy V, Stirnemann J, Vialard F, Vivanti A, Sananès N, Verspyck E. [Fetal death: Expert consensus from the College of French Gynecologists and Obstetricians]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:549-611. [PMID: 39153884 DOI: 10.1016/j.gofs.2024.07.005] [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: 08/19/2024]
Abstract
Fetal death is defined as the spontaneous cessation of cardiac activity after fourteen weeks of amenorrhea. In France, the prevalence of fetal death after 22 weeks is between 3.2 and 4.4/1000 births. Regarding the prevention of fetal death in the general population, it is not recommended to counsel for rest and not to prescribe vitamin A, vitamin D nor micronutrient supplementation for the sole purpose of reducing the risk of fetal death (Weak recommendations; Low quality of evidence). It is not recommended to prescribe aspirin (Weak recommendation; Very low quality of evidence). It is recommended to offer vaccination against influenza in epidemic periods and against SARS-CoV-2 (Strong recommendations; Low quality of evidence). It is not recommended to systematically look for nuchal cord encirclements during prenatal screening ultrasounds (Strong Recommendation; Low Quality of Evidence) and not to perform systematic antepartum monitoring by cardiotocography (Weak Recommendation; Very Low Quality of Evidence). It is not recommended to ask women to perform an active fetal movement count to reduce the risk of fetal death (Strong Recommendation; High Quality of Evidence). Regarding evaluation in the event of fetal death, it is suggested that an external fetal examination be systematically offered (Expert opinion). It is recommended that a fetopathological and anatomopathological examination of the placenta be carried out to participate in cause identification (Strong Recommendation. Moderate quality of evidence). It is recommended that chromosomal analysis by microarray testing be performed rather than conventional karyotype, in order to be able to identify a potentially causal anomaly more frequently (Strong Recommendation, moderate quality of evidence); to this end, it is suggested that postnatal sampling of the placental fetal surface for genetic purposes be preferred (Expert Opinion). It is suggested to test for antiphospholipid antibodies and systematically perform a Kleihauer test and a test for irregular agglutinins (Expert opinion). It is suggested to offer a summary consultation, with the aim of assessing the physical and psychological status of the parents, reporting the results, discussing the cause and providing information on monitoring for a subsequent pregnancy (Expert opinion). Regarding announcement and support, it is suggested to announce fetal death without ambiguity, using simple words and adapting to each situation, and then to support couples with empathy in the various stages of their care (Expert opinion). Regarding management, it is suggested that, in the absence of a situation at risk of disseminated intravascular coagulation or maternal vitality, the patient's wishes should be taken into account when determining the time between the diagnosis of fetal death and induction of birth. Returning home is possible if it's the patient wish (Expert opinion). In all situations excluding maternal life-threatening emergencies, the preferred mode of delivery is vaginal delivery, regardless the history of cesarean section(s) history (Expert opinion). In the event of fetal death, it is recommended that mifepristone 200mg be prescribed at least 24hours before induction, to reduce the delay between induction and delivery (Low recommendation. Low quality of evidence). There are insufficient data in the literature to make a recommendation regarding the route of administration (vaginal or oral) of misoprostol, neither the type of prostaglandin to reduce induction-delivery time or maternal morbidity. It is suggested that perimedullary analgesia be introduced at the start of induction if the patient asks, regardless of gestational age. It is suggested to prescribe cabergoline immediately in the postpartum period in order to avoid lactation, whatever the gestational age, after discussing the side effects of the treatment with the patient (Expert opinion). The risk of recurrence of fetal death after unexplained fetal death does not appear to be increased in subsequent pregnancies, and data from the literature are insufficient to make a recommendation on the prescription of aspirin. In the event of a history of fetal death due to vascular issues, low-dose aspirin is recommended to reduce perinatal morbidity, and should not be combined with heparin therapy (Low recommendation, very low quality of evidence). It is suggested not to recommend an optimal delay before initiating another pregnancy just because of the history of fetal death. It is suggested that the woman and co-parent be informed of the possibility of psychological support. Fetal heart rate monitoring is not indicated solely because of a history of fetal death. It is suggested that delivery not be systematically induced. However, induction can be considered depending on the context and parental request. The gestational age will be discussed, taking into account the benefits and risks, especially before 39 weeks. If a cause of fetal death is identified, management will be adapted on a case-by-case basis (expert opinion). In the event of fetal death occurring in a twin pregnancy, it is suggested that the surviving twin be evaluated as soon as the diagnosis of fetal death is made. In the case of dichorionic pregnancy, it is suggested to offer ultrasound monitoring on a monthly basis. It is suggested not to deliver prematurely following fetal death of a twin. If fetal death occurs in a monochorionic twin pregnancy, it is suggested to contact the referral competence center, in order to urgently look for signs of acute fetal anemia on ultrasound in the surviving twin, and to carry out weekly ultrasound monitoring for the first month. It is suggested not to induce birth immediately.
Collapse
Affiliation(s)
| | - Jeanne Sibiude
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, Paris, France
| | - Olivia Anselem
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, 75014 Paris, France
| | | | - Charline Bertholdt
- Pôle de gynécologie-obstétrique, pôle laboratoires, CHRU de Nancy, université de Lorraine, 54000 Nancy, France
| | - Julie Blanc
- Service de gynécologie-obstétrique, hôpital Nord, hôpitaux universitaires de Marseille, AP-HM, Marseille, France
| | - Matthieu Dap
- Pôle de gynécologie-obstétrique, pôle laboratoires, CHRU de Nancy, université de Lorraine, 54000 Nancy, France
| | | | - Catherine Fischer
- Service d'anesthésie, maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, Paris, France
| | - Aude Girault
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, 75014 Paris, France
| | - Paul Guerby
- Service de gynécologie-obstétrique, CHU de Toulouse, Toulouse, France
| | - Agnès Le Gouez
- Service d'anesthésie, hôpital Antoine-Béclère, AP-HP, université Paris Saclay, Clamart, France
| | - Hugo Madar
- Service de gynécologie-obstétrique, CHU de Bordeaux, 33000 Bordeaux, France
| | - Thibaud Quibel
- Service de gynécologie-obstétrique, CHI de Poissy Saint-Germain-en-Laye, Poissy, France
| | - Véronique Tardy
- Direction des plateaux médicotechniques, hospices civils de Lyon, Lyon, France; Département de biochimie biologie moléculaire, université Claude-Bernard Lyon, Lyon, France
| | - Julien Stirnemann
- Service de gynécologie-obstétrique, hôpital Necker, AP-HP, Paris, France
| | - François Vialard
- Département de génétique, CHI de Poissy Saint-Germain-en-Laye, Poissy, France
| | - Alexandre Vivanti
- Service de gynécologie-obstétrique, DMU santé des femmes et des nouveau-nés, hôpital Antoine-Béclère, AP-HP, université Paris Saclay, Clamart, France
| | - Nicolas Sananès
- Service de gynécologie-obstétrique, hôpital américain, Neuilly-sur-Seine, France
| | - Eric Verspyck
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, Rouen, France
| |
Collapse
|
2
|
Amirshahi M, Abdollahimohammad A, Shahdadi H, Firouzkouhi M. Women's Lived Experience of Fetal Death: A Descriptive Phenomenological. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241261109. [PMID: 38850164 DOI: 10.1177/00302228241261109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Pregnancy can be associated with risk factors that may lead to fetal loss, which is a profoundly distressing event impacting the psychological well-being, family dynamics, and overall quality of life of women. The present study aimed to explore women's lived experiences of fetal death. Conducted in 2023, this study employed a descriptive phenomenological approach, utilizing purposeful sampling to interview 12 pregnant women with a history of fetal loss. Data analysis was conducted using the seven-step method of Colaizzi. The study identified five main themes and fifteen sub-themes capturing women's experiences of fetal death. These themes include unfulfilled dreams, transitioning from happiness to grief, varied reactions among individuals, viewing a new healthy baby as a source of renewed hope, and the enduring long-term effects of fetal loss. Fetal death emerges as a deeply painful experience fraught with challenges for affected women. As such, these women require specialized attention from healthcare professionals, particularly midwives, gynecologists, and family specialists.
Collapse
Affiliation(s)
- Mehrbanoo Amirshahi
- Department of Midwifery, School of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, Iran
| | | | - Hossien Shahdadi
- Faculty of Nursing & Midwifery, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammadreza Firouzkouhi
- Department of Med Sur, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, Iran
| |
Collapse
|
3
|
Baas MAM, Stramrood CAI, Molenaar JE, van Baar PM, Vanhommerig JW, van Pampus MG. Continuing the conversation: a cross-sectional study about the effects of work-related adverse events on the mental health of Dutch (resident) obstetrician-gynaecologists (ObGyns). BMC Psychiatry 2024; 24:286. [PMID: 38627649 PMCID: PMC11022402 DOI: 10.1186/s12888-024-05678-3] [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] [Received: 11/20/2023] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Obstetrician-Gynaecologists (ObGyns) frequently face work-related adverse events such as severe obstetric complications and maternal or neonatal deaths. In 2014, the WATER-1 study showed that ObGyns are at risk of developing work-related posttraumatic stress disorder (PTSD), while many hospitals lacked a professional support system. The aim of the present study is to evaluate the current prevalence of work-related traumatic events and mental health problems among Dutch ObGyns, as well as to examine the current and desired support. METHODS In 2022, an online questionnaire was sent to all members of the Dutch Society of Obstetrics and Gynaecology (NVOG), including resident and attending ObGyns. The survey included questions about experienced work-related events, current and desired coping strategies, and three validated screening questionnaires for anxiety, depression, and PTSD (HADS, TSQ, and PCL-5). RESULTS The response rate was 18.8% and 343 questionnaires were included in the analysis. Of the respondents, 93.9% had experienced at least one work-related adverse event, 20.1% had faced a complaint from the national disciplinary board, and 49.4% had considered leaving the profession at any moment in their career. The prevalence rates of clinically relevant anxiety, depression, and psychological distress were 14.3, 4.4, and 15.7%, respectively. The prevalence of work-related PTSD was 0.9% according to DSM-IV and 1.2% according to DSM-5. More than half of the respondents (61.3%) reported the presence of a structured support protocol or approach in their department or hospital, and almost all respondents (92.6%) rated it as sufficient. CONCLUSIONS The percentages of anxiety, depression, psychological distress and PTSD are comparable to the similar study performed in 2014. Most Dutch ObGyns experience adverse events at work, which can be perceived as traumatic and, in certain cases, may lead to the development of PTSD. Structured support after adverse work-related events is now available in almost two-thirds of workplaces, and was mostly experienced as good. Despite substantial improvements in the availability and satisfaction of professional support after work-related adverse events, the prevalence rates of mental problems remain considerable, and it is imperative to sustain conversation about the mental well-being of ObGyns.
Collapse
Affiliation(s)
- Melanie A M Baas
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, 9700 RB, Groningen, PO box 30.001, The Netherlands
| | - Claire A I Stramrood
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Beval Beter, 1000 AH, Amsterdam, PO box 345, The Netherlands
| | - Jolijn E Molenaar
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
| | - Petra M van Baar
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, 1105 AZ, Amsterdam, the Netherlands
| | - Joost W Vanhommerig
- Department of Research and Epidemiology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands.
| |
Collapse
|
4
|
Leyland A, Choucri L. Student midwives' lived experiences of caring for bereaved parents following perinatal loss using actor-based simulation: A phenomenological study. Midwifery 2024; 130:103913. [PMID: 38241799 DOI: 10.1016/j.midw.2023.103913] [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: 03/25/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Student midwives frequently encounter bereaved parents in clinical practice; however, the experience of caring for bereaved parents can be a significant source of traumatic stress. Although the use of simulation to teach bereavement care is considered a powerful experiential form of learning, evidence for its effectiveness as a transformative learning strategy is limited. AIM To explore student midwives' lived experience of caring for bereaved parents experiencing perinatal loss using high-fidelity simulation. DESIGN Students midwives participated in an actor-based bereavement simulated scenario. Data was collected using semi-structured interviews. Interpretative Phenomenological Analysis was conducted to gain a deep understanding of the meaning of the experience. Mezirow's Transformative Learning Theory was applied as an analytical framework to illustrate how the student midwives made sense of and learned from the experience of caring for bereaved parents experiencing perinatal loss. SETTING One BSc (Hons), 156-week undergraduate midwifery programme within a university in the Northwest of England. PARTICIPANTS A purposeful sample of nine first-and second-year student midwives volunteered to participate in the study. FINDINGS One of the superordinate themes that emerged from the analysis (1) 'trying to console and making things easier' and the related subthemes (1a)'what words can I say', (1b)'my instinct was to console the mum', (1c)'left to sort of pick up the pieces' captured the deep sense of powerlessness and the professional dilemmas experienced as students struggled to emotionally console and communicate the right words to say to the grieving parents. CONCLUSION The study highlights the vital role of simulation as a defined model of bereavement education that equips students with the necessary knowledge, skills, and confidence to provide compassionate care to bereaved parents experiencing perinatal loss. IMPLICATIONS FOR PRACTICE The emotional toll of caring for bereaved parents is significant, and higher education institutions should adopt experiential forms of learning using actor-based simulation scenarios to emotionally prepare students to care holistically for parents affected by perinatal loss.
Collapse
Affiliation(s)
- Anne Leyland
- University of Salford, School of Health & Society, Frederick Road, Salford M6 6PU, UK.
| | - Lesley Choucri
- University of Salford, School of Health & Society, Frederick Road, Salford M6 6PU, UK
| |
Collapse
|
5
|
Galeotti M, Heaney S, Robinson M, Aventin Á. Evaluation of a pregnancy loss education intervention for undergraduate nursing students in Northern Ireland: A pre- and post-test study. BMC Nurs 2023; 22:268. [PMID: 37580730 PMCID: PMC10424365 DOI: 10.1186/s12912-023-01408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Research highlights the importance of compassionate communication, adequate delivery of information, and professional support to help alleviate parental distress following pregnancy loss. However, many healthcare professionals do not feel sufficiently trained to deal with pregnancy loss in practice. We aimed to address this deficiency with an evidence-informed educational intervention to increase knowledge, skills, self-awareness, and confidence regarding pregnancy loss among UK nursing students. METHODS Educational resources, which included an 82-minute podcast and 40-minute online lecture were developed. The podcast focused on the lived experiences of three women who had experienced miscarriage, stillbirth, and termination of pregnancy for medical reasons. The pre-recorded lecture included definitions of types of pregnancy loss, discussion of the importance of communication, and information on the clinical management of pregnancy loss. Students were presented with both the lecture and podcast as a self-directed element of existing curricula. A pre-test/post-test cross-sectional survey design was used to investigate the impact of the educational intervention. The Perinatal Bereavement Care Confidence Scale (PBCCS) was completed by 244 first year BSc Nursing students before and up to a week after receiving the intervention. Quantitative data were analysed using a Paired Samples Wilcoxon test. Responses to open-ended questions, which allowed students to give feedback on the intervention content and delivery were analysed using Qualitative Content Analysis. RESULTS 96% (n = 235) of the sample reported having no prior experience or training in the management and support of those experiencing pregnancy loss. At pre-test, 88% (n = 215) of students rated themselves as not confident in dealing with pregnancy loss in a professional capacity. Post-test, we found statistically significant effects for perceived competency on all learning outcomes (p < .001). Qualitative analysis of n = 745 individual text responses to open-ended questions indicated four categories related to the perceived value of using real-life stories for learning, demystifying a taboo subject, and providing tools for practice. Respondents suggested the inclusion of more information on memory-making, support networks, and mental health following pregnancy loss. CONCLUSIONS The educational intervention increased student nurses' perceived knowledge, confidence, and skills in caring for families experiencing pregnancy loss. This offers potential for increased quality of care for those experiencing pregnancy loss in healthcare settings, increased patient satisfaction, and improved mental health-related outcomes.
Collapse
Affiliation(s)
- Martina Galeotti
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Martin Robinson
- Stress, Trauma and Related Conditions Research Centre, School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| |
Collapse
|
6
|
Roche N, Darzins S, Oakman J, Stuckey R. Worker Experiences of the Work Health and Safety Impacts of Exposure to Dying and Death in Clinical Settings: A Qualitative Scoping Review. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221117902. [PMID: 36476137 DOI: 10.1177/00302228221117902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Workers employed in clinical healthcare settings often encounter dying and death of patients as a part of their role. This scoping review aimed to explore the physical and psychosocial OHS impacts on health workers exposed to death within their occupational role and their inherent coping strategies. Six electronic databases PsycINFO (Ovid), Medline (Ovid), AMED (EBSCO), CINAHL (EBSCO), and Proquest Social Sciences were searched for peer reviewed research articles published between March 1971 and April 2022. PRISMA-ScR guidelines were followed. Three authors independently assessed articles for inclusion. Fifty-three studies with focus settings in hospitals, hospice, general practice and residential care were identified. Five main themes were developed and organized using and ergonomic systems approach: Cultural Environment, Workplace, Job Demands, Impacts and Coping. The findings demonstrate that caring for dying patients, the dead and their families in clinical settings impacts workers emotionally, physically, behaviorally and spiritually.
Collapse
Affiliation(s)
- Natalie Roche
- Centre for Ergonomics and Human Factors, School of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Susan Darzins
- School of Allied Health, Australian Catholic University, Melbourne, VIC, Australia
| | - Jodi Oakman
- Centre for Ergonomics and Human Factors, School of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Rwth Stuckey
- Centre for Ergonomics and Human Factors, School of Public Health, La Trobe University, Melbourne, VIC, Australia
| |
Collapse
|
7
|
McNamara K, Smith A, Shine B, Cregan M, Prihodova L, O’Shaughnessy A, Martin A, Macdonald J, Kingston P, Fitzpatrick C, Hennessy M, O’Donoghue K. Addressing obstetricians' awareness of compassion, communication, and self-care when caring for families experiencing stillbirth: Evaluation of a novel educational workshop using applied drama techniques. PLoS One 2022; 17:e0277496. [PMID: 36395201 PMCID: PMC9671339 DOI: 10.1371/journal.pone.0277496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Obstetricians describe feeling shocked and isolated following stillbirth. Few receive adequate training in how to care for bereaved parents or themselves. We developed a novel workshop for trainee obstetricians using applied drama techniques-in collaboration with the National Theatre of Ireland, the national training body for obstetricians and gynaecologists, and patient support groups-to teach obstetricians skills in communication and self-care around the time of stillbirth. MATERIALS AND METHODS Five workshops, delivered January-May 2018, are the focus of this evaluation. Senior trainees in Obstetrics attended and completed a post-workshop evaluation questionnaire. Five-point Likert scales were used to assess participants' communication and support skills pre- and post- the workshop, and their views on pre-specified attributes needed when caring for families experiencing stillbirth and aspects of the workshop. Quantitative and qualitative data were analysed using descriptive statistics and content analysis, respectively. RESULTS 39/59 (66%) workshop participants completed the questionnaires. Most had received no prior training in caring for families experiencing antenatal (31/39, 80%) or intrapartum (34/39, 87%) stillbirth. Following the workshop there was a significant improvement in trainee's level of confidence in breaking bad news, communicating clearly with the family when breaking bad news, recognising the emotional needs of the family, recognising their own emotional responses, and supporting their colleagues. Trainees were positive about the workshop content and delivery; 90% stated they would recommend it to a colleague. DISCUSSION Adequate, appropriate, and stimulating education and training in stillbirth care and self-care is clearly needed to improve patient care. Our findings demonstrate that this novel educational workshop using applied drama techniques-developed in collaboration with diverse stakeholders and underpinned by the views of parents and obstetricians who had experience of stillbirth-is an acceptable and appropriate way of training obstetricians in how to care for bereaved parents and/or to engage in self-care.
Collapse
Affiliation(s)
- Karen McNamara
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Aisling Smith
- Royal College of Physicians of Ireland, Dublin, Ireland
| | - Brid Shine
- Coombe Women & Infants University Hospital, Dublin, Ireland
| | - Mairie Cregan
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Féileacáin, Stillbirth and Neonatal Death Association of Ireland, Cork, Ireland
| | | | | | - Aisling Martin
- Coombe Women & Infants University Hospital, Dublin, Ireland
- UCD Centre for Human Reproduction, Dublin, Ireland
| | | | | | - Chris Fitzpatrick
- Coombe Women & Infants University Hospital, Dublin, Ireland
- UCD Centre for Human Reproduction, Dublin, Ireland
| | - Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
- * E-mail:
| | - Keelin O’Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| |
Collapse
|
8
|
O'Meara S, D'Arcy F, Dowling C, Walsh K. The psychological impact of adverse events on urology trainees. Ir J Med Sci 2022:10.1007/s11845-022-03202-8. [PMID: 36329289 PMCID: PMC9633123 DOI: 10.1007/s11845-022-03202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Introduction Adverse events (AE) are an inevitable reality in healthcare, with an incidence of 7.5–14.1% worldwide. AEs are recognised to cause psychological and emotional distress in healthcare workers, with surgeons being particularly susceptible. We report the first data on the emotional impact in relation to adverse events in surgeons in the Republic of Ireland (ROI). Methods We distributed a web-based survey to all urology trainees in the ROI. The questionnaire focused on trainees’ personal account of AEs, their emotional response, perceived contributing factors and perceived benefit of support systems. The primary care PTSD screen (PC-PTSD-V) assessed for PTSD. Results A total of 16 responses were received from 12 (75%) registrars and 4 (25%) SHOs. Of the AEs reported, 12 (75%) were ≥ Clavien-Dindo 3b. Contributing factors identified included lapse of judgement (n = 6, 37.5%), risk of procedure (n = 7, 43%), lack of experience (n = 4, 25%). Anxiety (n = 8, 50%), guilt (n = 7, 44%) and sleep problems (n = 4, 25%) were the most reported emotional responses. Physical symptoms were reported in 2 (12%) trainees. A PC-PTSD-V score ≥ 3 was reported in 2 (12%) trainees. Most trainees (n = 13, 81%) reported talking to someone following the event with most (n = 12, 93%) talking to a consultant or NCHD colleague. Most respondents (n = 14, 87%) agreed that their training could better prepare them for the personal impact of AEs. Conclusion Surgical trainees report negative psychological and emotional responses that are consistent with second victim symptoms. Those surveyed felt that their training could better prepare them for the personal impact of such events. Supplementary Information The online version contains supplementary material available at 10.1007/s11845-022-03202-8.
Collapse
Affiliation(s)
- Sorcha O'Meara
- Department of Urology, University College Hospital Galway, Galway, Ireland.
| | - Frank D'Arcy
- Department of Urology, University College Hospital Galway, Galway, Ireland
| | - Catherine Dowling
- Department of Urology, University College Hospital Galway, Galway, Ireland
| | - Kilian Walsh
- Department of Urology, University College Hospital Galway, Galway, Ireland
| |
Collapse
|
9
|
Helps Ä, Leitao S, O'Byrne L, Greene R, O'Donoghue K. Governance of maternity services: Effects on the management of perinatal deaths and bereavement services. Midwifery 2021; 101:103049. [PMID: 34126337 DOI: 10.1016/j.midw.2021.103049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND External inquiries are carried out following adverse maternal/perinatal events, to examine the care provided and make recommendations to improve it. Clinical governance ensures that organisations promote high-quality care and are accountable for the care they provide, thus contributing to its improvement. OBJECTIVE This study examined how Irish perinatal bereavement services and the management of perinatal deaths (including events leading up to the deaths) were affected by developments in maternity services governance as described in ten Irish enquiry reports published over 14 years (2005-18). METHODS Two clinicians collected data from the ten enquiry reports by using a specifically designed review tool. Thematic analysis was carried out, following the steps of familiarising, coding, identifying, grouping and revising themes. FINDINGS Seven main themes were identified: workforce, leadership, management of risk, work environment, hospital oversight, national documents, data collection. Eight reports noted shortcomings in staffing levels, with a workforce that was under-resourced, and at times carried excessive workloads. The absence of 24/7 midwifery-shift leaders in maternity units resulted in problems with care at times not being escalated appropriately. The absence of a widely-owned, understood strategic plan for the management of the maternity services was mentioned in the reports from 2013. Conclusions and implications for practice The National Bereavement Care Standards were published in 2016 to address deficiencies identified in the enquiry reports and to standardise perinatal bereavement care across Irish maternity units. Though the first Irish Maternity Strategy (2016-26) was published in 2016, its implementation is incomplete. Inconsistencies remain in the definition and collection of national perinatal data, as well as concerns regarding the lack of local audit activities on pregnancy outcomes. Greater focus on hospital oversight, implementation of national documents and reliable data collection is required. To be effective and initiate positive changes in clinical services, documents such as incident reviews, national strategies and national reports including inquiries, need to include realistic recommendations with clear timelines and responsibilities for implementation.
Collapse
Affiliation(s)
- Änne Helps
- Pregnancy Loss Research Group, The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - Sara Leitao
- Pregnancy Loss Research Group, The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland
| | - Laura O'Byrne
- Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Richard Greene
- National Perinatal Epidemiology Centre (NPEC), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland
| |
Collapse
|
10
|
McCarthy C, Meaney S, Rochford M, O’Donoghue K. Risk perception on the labour ward: A mixed methods study. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211002428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Healthcare providers commonly experience risky situations in the provision of maternity care, and there has been increased focus on the lived experience in recent years. We aimed to assess opinions on, understanding of and behaviours of risk on the LW by conducting a mixed methods study. Staff working in a LW setting completed a descriptive questionnaire-based study, followed by qualitative structured interviews. Statistical analysis was performed with SPSS on quantitative data and thematic analysis performed on qualitative data. Nearly two thirds of staff (64%; 73/114) completed the questionnaire, with 56.2% (n = 47) experiencing risk on a daily basis. Experiencing risk evoked feelings of apprehension (68.4%; n = 50) and worry (60.2%; n = 44) which was echoed in the qualitative work. Structured clinical assessment was utilised in risky situations, and staff described “ going on autopilot” to manage these situations. A large number of respondents reflected on their provision of care following an adverse event (87.7%; n = 64). Debriefing was mentioned as an important practice following such events by all respondents. This study describes the negative terminology prevailing in emergency obstetric care. These experiences can have a profound impact on staff. Risk reduction strategies and the provision of increased staff support and training are crucial to improve staff wellbeing in stressful scenarios.
Collapse
Affiliation(s)
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Marie Rochford
- Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Keelin O’Donoghue
- Cork University Maternity Hospital, Wilton, Cork, Ireland and The Irish Centre for Fetal and Neonatal Translational, Research (INFANT), University College Cork, Cork, Ireland
| |
Collapse
|
11
|
Choummanivong M, Karimi S, Durham J, Sychareun V, Flenady V, Horey D, Boyle F. Stillbirth in Lao PDR: a healthcare provider perspective. Glob Health Action 2021; 13:1786975. [PMID: 32741353 PMCID: PMC7480497 DOI: 10.1080/16549716.2020.1786975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Stillbirth is a major global concern. However, most research has been conducted in high-income countries. Understanding of the experience and management of stillbirth in low-middle income countries is needed. Objective This qualitative study explored health professionals’ experiences of providing stillbirth care in the Lao People’s Democratic Republic, a lower-middle-income country in South-East Asia. Methods In-depth interviews were conducted with 33 health professionals (doctors, midwives and nurses) and thematic analysis was undertaken. Results All participants acknowledged stillbirth as a concern, but its incidence and causes were largely undocumented and unknown. A lack of training in managing stillbirth left health professionals often ill-equipped to support mothers and provide responsive care. Social stigma surrounds stillbirth, meaning mothers found limited support or opportunities to openly express their grief. Conclusions Better awareness of stillbirth causes could promote more positive experiences for healthcare providers and parents and more responsive healthcare. This requires improved training for healthcare professionals and awareness raising in the wider community.
Collapse
Affiliation(s)
- Molina Choummanivong
- Faculty of Public Health Department, University of Health Sciences , Vientiane, Lao People's Democratic Republic
| | - Sediqa Karimi
- School of Public Health, The University of Queensland , Brisbane, Australia.,Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland , Brisbane, Australia
| | - Joanne Durham
- School of Public Health and Social Work, Queensland University of Technology , Brisbane, Australia
| | - Vanphanom Sychareun
- Faculty of Public Health Department, University of Health Sciences , Vientiane, Lao People's Democratic Republic
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland , Brisbane, Australia
| | - Dell Horey
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland , Brisbane, Australia.,Public Health, School of Psychology and Public Health, La Trobe University , Melbourne, Australia
| | - Fran Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland , Brisbane, Australia.,Institute for Social Science Research, The University of Queensland , Brisbane, Australia
| |
Collapse
|
12
|
Power S, Meaney S, O'Donoghue K. Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study. BJOG 2020; 128:676-684. [PMID: 32935467 DOI: 10.1111/1471-0528.16502] [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] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore fetal medicine specialists' experiences of caring for parents following a diagnosis of fatal fetal anomaly (FFA) during the implementation of termination of pregnancy (TOP) for FFA for the first time. DESIGN Qualitative study. SETTING Fetal medicine units in the Republic of Ireland. POPULATION Ten fetal medicine specialists from five of the six fetal medicine units. METHODS nvivo 12 assisted in the thematic analysis of semi-structured in-depth face-to-face interviews. MAIN OUTCOME MEASURES Fetal medicine specialists' experiences of prenatal diagnosis and holistic management of pregnancies complicated by FFA. RESULTS Four themes were identified: 'not fatal enough', 'interactions with colleagues', 'supporting pregnant women' and 'internal conflict and emotional challenges'. Fetal medicine specialists feared getting an FFA diagnosis incorrect because of media scrutiny and criminal liability associated with the TOP for FFA legislation. Challenges with the ambiguous and 'restrictive' legislation were identified that 'ostracised' severe anomalies. Teamwork was essential to facilitate opportunities for learning and peer support; however, conflict with colleagues was experienced regarding the diagnosis of FFA, the provision of feticide and palliative care to infants born alive following TOP for FFA. Participants reported challenges implementing TOP for FFA, including the absence of institutional support and 'stretched' resources. Fetal medicine specialists experienced internal conflict and a psychological burden providing TOP for FFA, but did so to 'provide full care for women'. CONCLUSIONS Our study identified challenges regarding the suitability of the Irish legislation for TOP for FFA and its rapid introduction into clinical practice. It illustrates the importance of institutional and peer support, as well as the need for supportive management, in the provision of a new service. TWEETABLE ABSTRACT The implementation of termination services for fatal fetal anomaly is complex and requires institutional support.
Collapse
Affiliation(s)
- S Power
- The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland.,Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - S Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - K O'Donoghue
- The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland.,Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| |
Collapse
|
13
|
Matsubara S, Matsubara D, Matsubara T. Burnout and devastated feeling on patient's death: Universal to clinicians. Aust Crit Care 2020; 32:275-276. [PMID: 31277759 DOI: 10.1016/j.aucc.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Daisuke Matsubara
- Division of Pediatric Cardiology of Department of Pediatrics, Jichi Medical University, Tochigi, Japan.
| | - Teppei Matsubara
- Department of Clinical Neurophysiology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| |
Collapse
|
14
|
Shawer S, Rowbotham S, Heazell A, Kelly T, Vause S. Impact of consultant obstetric presence on serious incidents. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2019. [DOI: 10.1108/ijhg-12-2018-0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Many organisations, including the Royal College of Obstetricians and Gynaecologists, have recommended increasing the number of hours of consultant obstetric presence in UK National Health Service maternity units to improve patient care. St Mary’s Hospital, Manchester implemented 24-7 consultant presence in September 2014. The paper aims to discuss these issues.
Design/methodology/approach
To assess the impact of 24-7 consultant presence upon women and babies, a retrospective review of all serious clinical intrapartum incidents occurring between September 2011 and September 2017 was carried out by two independent reviewers; disagreements in classification were reviewed by a senior Obstetrician. The impact of consultant presence was classified in a structure agreed a priori.
Findings
A total of 72 incidents were reviewed. Consultants were directly involved in the care of 75.6 per cent of cases before 24-7 consultant presence compared to 96.8 per cent afterwards. Negative impact due to a lack of consultant presence fell from 22 per cent of the incidents before 24-7 consultant presence to 9.7 per cent after implementation. In contrast, positive impact of consultant presence increased from 14.6 to 32.3 per cent following the introduction of 24-7 consultant presence.
Practical implications
Introduction of 24-7 consultant presence reduced the negative impact caused by a lack of, or delay in, consultant presence as identified by serious untoward incident (SUI) reviews. Consultant presence was more likely to have a positive influence on care delivery.
Originality/value
This is the first assessment of the impact of 24-7 consultant presence on the SUIs in obstetrics.
Collapse
|
15
|
Matsubara S, Takahashi H, Suzuki T. Mode of delivery of triplet pregnancy: hidden factors that should be considered. Arch Gynecol Obstet 2018; 298:459-460. [DOI: 10.1007/s00404-018-4854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022]
|
16
|
Matsubara S. Psychological burden on obstetricians caused by patients' deaths. Acta Obstet Gynecol Scand 2018; 97:1405. [PMID: 29923179 DOI: 10.1111/aogs.13411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| |
Collapse
|
17
|
Affiliation(s)
- Matthew Cauldwell
- Department of Obstetrics and Gynecology, St Thomas' Hospital, London, UK
| | - Susan Bewley
- Professor of Complex Obstetrics, King's College London, London, UK
| |
Collapse
|