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Ruan J, Zhong X, Mai J, Liu C, Ding H. The status and influencing factors of abnormal fetal pregnancy outcomes in 265 cases in China: a retrospective study. PeerJ 2024; 12:e17284. [PMID: 38685940 PMCID: PMC11057424 DOI: 10.7717/peerj.17284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Background With the advancement of prenatal diagnosis technology, the detection rate of fetal abnormalities continues to increase, imposing a significant burden on both society and families. A retrospective analysis of essential information about pregnant women, such as their pregnancy history and delivery details, is crucial for understanding the primary factors that influence pregnancy outcomes in women with fetal abnormalities. This analysis is of great significance for improving the level of pregnancy management and outcomes in pregnant women with fetal abnormalities. Objective To retrospectively analyze the pregnancy outcomes of women with fetal abnormalities and explore the factors that influence these outcomes. Methods Pregnant women's pregnancy outcomes were collected from the medical information system and through telephone follow-ups. The chi-square test and logistic regression were used to analyze the factors influencing pregnancy outcomes. Results Among 265 pregnant women diagnosed with fetal abnormalities, 190 chose to continue the pregnancy, while 75 chose to terminate it. Pregnant women with multiple fetal abnormalities (OR = 3.774, 95% CI [1.640-8.683]) were more likely to choose termination of pregnancy (TOP), and pregnant women who were advised to terminate their pregnancy or make a careful choice were more likely to terminate the pregnancy (OR = 41.113, 95% CI [11.028-153.267]). Conclusion The number of organs involved in fetal abnormalities and treatment recommendations were identified as the primary factors influencing pregnancy outcomes. Improving awareness of maternal health care during pregnancy, early pregnancy screening technology, and a multidisciplinary diagnosis and treatment approach are of great significance in assisting pregnant women in making informed decisions and improving fetal prognosis.
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Affiliation(s)
- Jing Ruan
- Department of Nursing, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Xuemei Zhong
- Breast Surgery, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Jiaxuan Mai
- Neonatal Surgery Department, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Cuifen Liu
- Fetal Life Cycle Clinic, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Huiyang Ding
- Neonatal Surgery Department, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
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Hjort-Pedersen K, Olesen AW, Garne E, Toerring PM, Wu C, Sperling L. Parental information about the option to apply for pregnancy termination after the detection of a congenital abnormality and factors influencing parental decision-making: a cohort study. BMC Pregnancy Childbirth 2022; 22:948. [PMID: 36528557 PMCID: PMC9759856 DOI: 10.1186/s12884-022-05255-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The detection of an abnormality during prenatal screening implies that the parents are informed about possible treatment and management of the pregnancy, birth, and postnatal course. This information should enable the parents to make decisions regarding the pregnancy, especially in cases where termination of pregnancy may be an option. The objectives of this study were to investigate how often doctors informed parents about pregnancy termination when the fetus had an anomaly and which demographic factors were related to parental decision-making. METHODS This was a retrospective cohort study with prospectively collected data of fetuses diagnosed with an abnormality during prenatal screening between 2014 and 2016 in Denmark. We categorized the abnormalities into five long-term prognosis groups and analyzed their association with the doctor provided information about termination. We tested the association between demographic variables and parental decisions using univariate and multivariate statistical analyses. RESULTS Three hundred and twenty fetuses were diagnosed with an abnormality. In 67% of these cases, the parents were informed about termination. All parents whose fetus had a lethal prognosis were informed about termination. By comparison, the parents of 98% of fetuses with genetic disorders, 96% of fetuses with poor prognosis, 69% of fetuses with uncertain prognosis, and 12% of fetuses with good prognosis were informed about termination. Of these parents, 92% chose to terminate. A lethal long-term prognosis was the only factor related to parental decision to terminate a pregnancy. CONCLUSIONS Doctors mainly informed parents about the option of pregnancy termination for conditions with a poor or lethal long-term prognosis or for genetic disorders. Only conditions with a lethal prognosis were significantly related to the parental decision to terminate the pregnancy.
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Affiliation(s)
- Karina Hjort-Pedersen
- grid.7143.10000 0004 0512 5013Research Unit of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Odense Patient Data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Annette Wind Olesen
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ester Garne
- grid.459623.f0000 0004 0587 0347Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | | | - Chunsen Wu
- grid.7143.10000 0004 0512 5013Research Unit of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Sperling
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
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Cortezzo DE, Ellis K, Schlegel A. Perinatal Palliative Care Birth Planning as Advance Care Planning. Front Pediatr 2020; 8:556. [PMID: 33014940 PMCID: PMC7505922 DOI: 10.3389/fped.2020.00556] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose of Review: A significant number of pregnancies are complicated by a fetus with a life-limiting diagnosis. As diagnoses are made earlier in the pregnancy, families experience anticipatory grief and are faced with navigating goals of care for a baby that has yet to be born. With the support of the care team, families can begin to grieve, plan, and make meaningful memories during the duration of the pregnancy, the birth of their baby, and life of the child. Creating a palliative care birth plan, which expands beyond the traditional concept for delivery planning to include prenatal, perinatal, and neonatal care has become an important method for parents to process the diagnosis, for parents to document their wishes, and for members of the care team to communicate with the goal of supporting and enhancing the experience of the family. This articles reviews recent and relevant literature on the importance of birth planning and the role of perinatal palliative care when a life-limiting fetal diagnosis is made. Recent Findings: The process of birth planning is an important component of perinatal palliative care. Through this process, families can express their fears, values, hopes, and wishes. It also offers an opportunity for providers to communicate these wishes for the remainder of the pregnancy, the delivery, birth, and time afterwards. This has been demonstrated to decrease maternal stress and promote family centered care. Summary: Perinatal birth planning is an important component of perinatal palliative care when a fetus has a life-limiting diagnosis. The process of birth planning can be supportive and therapeutic as well as an important communication tool. With multiple practices and designs of perinatal palliative care programs, there are no standard tools even though important components have been identified. Ultimately, the strategies outlined here can be used as advance care planning tools.
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Affiliation(s)
- DonnaMaria E Cortezzo
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kelstan Ellis
- Department of Pediatrics, University of Missouri Kansas City, Kansas City, MO, United States.,Section on Palliative Care, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Amy Schlegel
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, Ohio State University of Medicine, Columbus, OH, United States
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Michalik A, Zdun-Ryżewska A, Pięta B, Basiński K, Kiełbasińska J, Mazurkiewicz B, Olszewska J, Łukaszuk K. Multicenter study on midwifery students' attitudes towards abortion and it's place in their future practice - Comparison of respondents at early and late stages of the university education. Nurse Educ Pract 2019; 35:42-47. [PMID: 30665059 DOI: 10.1016/j.nepr.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/20/2018] [Accepted: 01/09/2019] [Indexed: 11/27/2022]
Abstract
Evidence based midwifery education and practice are fundamental to assure high quality care of childbearing women, also with complications. In Poland, midwifery education includes aspects of participation in the abortion. A cross-sectional study was designed to describe the attitudes towards abortion at the beginning and at the end of students' university education. The study was aimed to verify change of attitudes throughout the course of the university education. Most of the students approved abortion if the pregnancy constitutes a threat to woman's health or life, results from a rape, or whenever the fetus presents with a lethal defect. More than a half did not approve participation in the abortion if the fetus presents with a non-lethal defect. Generally, the acceptance rates were significantly higher among the final year students, but more than a half of them stated, that the abortion-related topics were inadequately addressed in their study curriculum. That bring to the conclusion that higher rates of abortion acceptance among the final year students, were not necessarily a manifestation of informed approval for this procedure, but rather a form of a "systemic" adjustment. Midwifery program need to be revised to support students in developing informed and evidence-based attitudes toward abortion.
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Affiliation(s)
- Anna Michalik
- Department of Obstetrical and Gynecological Nursing, Medical University of Gdansk, 80-211, Gdansk, Debinki 7, Poland.
| | - Agata Zdun-Ryżewska
- Department of Quality of Life Research, Medical University of Gdansk, 80-210, Gdansk, Tuwima 15, Poland.
| | - Beata Pięta
- Department of Mother's and Child's Health, University of Medical Sciences, 60-512, Poznan, Jackowskiego 42, Poland.
| | - Krzysztof Basiński
- Department of Quality of Life Research, Medical University of Gdansk, 80-210, Gdansk, Tuwima 15, Poland.
| | - Joanna Kiełbasińska
- Department of Gynecologic and Obstetrical Didactics, Warsaw Medical University, 00-424, Warsaw, Żwirki I Wigury 81, Poland.
| | - Barbara Mazurkiewicz
- Department of Gynecologic and Obstetrical Didactics, Warsaw Medical University, 00-424, Warsaw, Żwirki I Wigury 81, Poland.
| | - Jolanta Olszewska
- Department of Obstetrical and Gynecological Nursing, Medical University of Gdansk, 80-211, Gdansk, Debinki 7, Poland.
| | - Krzysztof Łukaszuk
- Department of Obstetrical and Gynecological Nursing, Medical University of Gdansk, 80-211, Gdansk, Debinki 7, Poland.
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