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Papastefan ST, Bian Y, Singh M, Marriott WS, Ito JA, Fry J, Shaaban AF, Premkumar A. Neighborhood deprivation is not associated with abortion consideration or completion in patients with fetal myelomeningocele. Prenat Diagn 2024. [PMID: 38982329 DOI: 10.1002/pd.6633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/06/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate whether patient-level neighborhood deprivation index (NDI) was associated with termination of pregnancy consideration and completion in patients presenting with fetal myelomeningocele. METHODS This was a retrospective cohort analysis of patients with fetal myelomeningocele presenting to a fetal treatment center (FTC) in Illinois between 2018 and 2024. The exposure was NDI calculated from patient zip codes. The NDI was analyzed as both a dichotomous and ordinal exposure. The co-primary outcomes were abortion consideration prior to FTC consultation, ascertained by nurse intake, and abortion completion after consultation. Bivariate and log-binomial regression analyses were performed. Covariates were selected based on p < 0.10 on bivariate analyses. Otherwise, p < 0.05 indicated statistical significance. RESULTS A total of 157 participants were included. Evaluation of neighborhood deprivation as a dichotomous exposure revealed no association with abortion consideration or completion. AdditionallLy, no association was found on log binomial modeling after controlling for gestational age at presentation to the FTC and maternal race or ethnicity for abortion consideration (aRR 0.87, 95% CI 0.59-1.28) or completion (aRR 0.86, 95% CI 0.59-1.28). These results were similar when treating the NDI as an ordinal exposure. CONCLUSIONS Contrary to our hypothesis, NDI is not associated with abortion consideration or completion in patients with fetal myelomeningocele.
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Affiliation(s)
- Steven T Papastefan
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yuqi Bian
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Humanities and Bioethics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Manmeet Singh
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - William S Marriott
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Joyceline A Ito
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jessica Fry
- Neonatology and Palliative Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Aimen F Shaaban
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashish Premkumar
- Department of Obstetrics and Gynecology, Section of Maternal Fetal Medicine, Pritzker School of Medicine at the University of Chicago, Chicago, Illinois, USA
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Zhou M, Li X, Huang C, Xie J, Liu L, Wang Y, Xiao G, Zhang T, Qin C. Needs for supporting women undergoing termination of pregnancy for fetal anomaly: A phenomenological study based on the cognitive-emotional-behavioral framework. Midwifery 2023; 123:103726. [PMID: 37192569 DOI: 10.1016/j.midw.2023.103726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/29/2023] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To determine and describe the needs of women undergoing termination of pregnancy for fetal anomaly (TOPFA) in China. STUDY DESIGN Qualitative study with semi-structured interviews. Consolidated Criteria for Reporting Qualitative Studies checklist was used for reporting. SETTING Three general hospitals and one special hospital in Changsha, Hunan, China. PARTICIPANTS 12 women who had undergone TOPFA and 12 healthcare providers who had experienced in caring for these women. METHODS This study was based on the cognitive-emotional-behavioral framework (CEBF) of women who had to undergo TOPFA. Twenty-four participants (12 women and 12 healthcare providers) were recruited from two hospitals in China. Semi-structured face-to-face interviews were conducted based on interview guides. ATLAS.ti software was used to encode and analyze data. Qualitative content analysis was also applied. FINDINGS Four themes emerged: information, emotional, professional psychological, and social supports. Each theme was subdivided into four phases for a detailed description of the temporal order (denial, confirmation, decision-making, and recovery phases) within the framework. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Our study analyzes the four needs of women who underwent TOPFA and the specifics of each need at different phases based on the CEBF. The importance of offering professional psychological support, detailed information, timely emotional support, and comprehensive social support for these women is illustrated. This study contributes to the understanding of women's needs, hence providing a theoretical basis for the construction of supportive programs.
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Affiliation(s)
- Mengjia Zhou
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Xi Li
- School of Medicine, Jishou University, Jishou, China
| | - Chi Huang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Jiaying Xie
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Li Liu
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Ying Wang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Gui Xiao
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Tingting Zhang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Chunxiang Qin
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China.
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Malope MF, Stewart C, Fieggen KJ, Wessels TM. The decision-making process of pregnant individuals offered termination of pregnancy for serious congenital abnormalities. PATIENT EDUCATION AND COUNSELING 2023; 112:107745. [PMID: 37071936 DOI: 10.1016/j.pec.2023.107745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This study aimed to explore the decision-making process of patients with pregnancies affected by serious congenital abnormalities. METHODS The study design was an exploratory qualitative study. The sample for this study was pregnant individuals who had a prenatal diagnosis of a serious congenital abnormality and were offered termination of pregnancy. Semi-structured face-to-face interviews with closed and open-ended questions, recorded and transcribed verbatim, were used to collect the data; this was then analyzed using a thematic data analysis approach. RESULTS Five topics were developed: "Health care services", "Home", "Being a mother", "Finding meaning", and "The aftermath". The first four topics describe the decision-making process where the participants filtered through multiple factors to reach their final decision. Although the participants consulted with their families, partners, and community, they made the final decision themselves. The final topics describes activities which were necessary for closure and coping. CONCLUSION This study has provided valuable insight into the decision-making process, which can be used to improve services offered to patients. PRACTICE IMPLICATIONS Information should be communicated clearly with follow-up appointments to discuss further. Healthcare professional should show empathy and assure the participants that their decision is supported.
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Affiliation(s)
| | - Chantal Stewart
- Department of Obstetrics & Gynecology, University of Cape Town, Cape Town, South Africa
| | - Karen J Fieggen
- Department of Pathology, University of Cape Town, Cape Town 7935, South Africa
| | - Tina-Marié Wessels
- Department of Pathology, University of Cape Town, Cape Town 7935, South Africa
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Heaney S, Tomlinson M, Aventin Á. Termination of pregnancy for fetal anomaly: a systematic review of the healthcare experiences and needs of parents. BMC Pregnancy Childbirth 2022; 22:441. [PMID: 35619067 PMCID: PMC9137204 DOI: 10.1186/s12884-022-04770-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/16/2022] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Improved technology and advances in clinical testing have resulted in increased detection rates of congenital anomalies during pregnancy, resulting in more parents being confronted with the possibility of terminating a pregnancy for this reason. There is a large body of research on the psychological experience and impact of terminating a pregnancy for fetal anomaly. However, there remains a lack of evidence on the holistic healthcare experience of parents in this situation. To develop a comprehensive understanding of the healthcare experiences and needs of parents, this systematic review sought to summarise and appraise the literature on parents' experiences following a termination of pregnancy for fetal anomaly. REVIEW QUESTION What are the healthcare experiences and needs of parents who undergo a termination of pregnancy following an antenatal diagnosis of a fetal anomaly? METHODS A systematic review was undertaken with searches completed across six multi-disciplinary electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane). Eligible articles were qualitative, quantitative or mixed methods studies, published between January 2010 and August 2021, reporting the results of primary data on the healthcare experiences or healthcare needs in relation to termination of pregnancy for fetal anomaly for either, or both parents. Findings were synthesised using Thematic Analysis. RESULTS A total of 30 articles were selected for inclusion in this review of which 24 were qualitative, five quantitative and one mixed-methods. Five overarching themes emerged from the synthesis of findings: (1) Contextual impact on access to and perception of care, (2) Organisation of care, (3) Information to inform decision making, (4) Compassionate care, and (5) Partner experience. CONCLUSION Compassionate healthcare professionals who provide non-judgemental and sensitive care can impact positively on parents' satisfaction with the care they receive. A well organised and co-ordinated healthcare system is needed to provide an effective and high-quality service. TRIAL REGISTRATION PROSPERO registration number: CRD42020175970 .
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Affiliation(s)
- Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland.
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland
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Albu CC, Albu DF, Pătraşcu A, Albu ŞD, Efrem IC, Gogănău AM. Prenatal diagnosis of syndromic alobar holoprosencephaly associated with digynic triploidy fetus. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:1309-1316. [PMID: 34171079 PMCID: PMC8343603 DOI: 10.47162/rjme.61.4.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Holoprosencephaly (HPE) is a dramatic human brain malformation sequence with an extreme variable phenotypic spectrum and genetic heterogeneity, variable degree of severity and unknown etiology, in many cases. HPE is classified into syndromic, chromosomal, and non-syndromic, non-chromosomal. The most cases of HPE are syndromic. We present an atypical case of syndromic alobar HPE associated with digynic triploidy fetus, prenatally diagnosed, early at 18 weeks of gestation, by ultrasound (US) and complex genetic investigations. The US examination was performed with a specialized US machine, General Electric Voluson E10 OLED BT18, using two-dimensional (2D) scanning, three-dimensional (3D) image reconstruction, four-dimensional (4D) spatiotemporal image methodology and the highest power Doppler US technology. A detailed US examination of the fetus revealed several major abnormalities of the fetal head and severe facial malformations. Based on the antenatal US findings, the fetus was diagnosed with alobar HPE. After a careful examination and genetic counseling, additional cytogenetic investigations and molecular genetic analyses were performed, which revealed an abnormal number of 69 chromosomes, digynic triploidy (69,XXY). Two days later, the parents choose to interrupt the current gestation because of major fetal malformations. The pathological examination of the embryo reaffirmed the antenatal diagnostics.
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Affiliation(s)
- Cristina Crenguţa Albu
- Department of Genetics, Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; ,
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The Influence of Abortion Law on the Frequency of Pregnancy Terminations-A Retrospective Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084099. [PMID: 33924551 PMCID: PMC8070645 DOI: 10.3390/ijerph18084099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/28/2022]
Abstract
Abortion law is one of the main factors influencing the number of abortions performed in a country. The study aimed to assess the influence of abortion law on the number of performed terminations with particular attention paid to pregnancy terminations due to fetal defects. The retrospective comparative analysis of statistical data included on the governmental websites of Poland and the UK was performed. The average of 190,733.1 terminations were performed in the United Kingdom in the years 2009–2018 with the average of 2820.9 due to fetal defects. At the same time the average of 858.6 terminations were performed in Poland with 820.7 due to fetal defects. Population size is the only significant predictor of the number of terminations in the United Kingdom. The increase in the number of deliveries and population in Poland was not linked to the increase in the overall number of terminations or terminations due to fetal defects. It might be due to the unavailability of pregnancy terminations in many places. The radicalization of abortion law exerts no influence on the decrease in the number of terminations due to fetal indications. The liberalization of abortion law promotes the increase in the number of terminations due to social indications.
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Banasiewicz J, Zaręba K, Rozenek H, Ciebiera M, Jakiel G, Chylińska J, Owczarek K. Adaptive capacity of midwives participating in pregnancy termination procedures: Polish experience. Health Psychol Open 2020; 7:2055102920973229. [PMID: 33343915 PMCID: PMC7731597 DOI: 10.1177/2055102920973229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A cross-sectional study was conducted in 181 midwives working in hospitals in Poland. The midwives completed professional psychological tests (CISS questionnaire, EPQ-R questionnaire, OLBI questionnaire) and a questionnaire developed for this study. Midwives participating in pregnancy termination procedures most commonly used the task-oriented coping style. The emotion-oriented coping style was positively related to burnout in the group which performed pregnancy terminations. The analysis showed that the higher the indices of neuroticism, the greater the severity of burnout in both groups. The results indicate the need to conduct an initial assessment of personality resources when employing midwives to the wards.
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Affiliation(s)
- Jolanta Banasiewicz
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, Poland
| | - Kornelia Zaręba
- I Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Hanna Rozenek
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, Poland
| | - Michał Ciebiera
- II Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Grzegorz Jakiel
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, Poland
| | - Joanna Chylińska
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, Poland
| | - Krzysztof Owczarek
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, Poland
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Sun S, Yang M, Zhang J, Zhou X, Jia G, Yu X. Family support for pregnant women with foetal abnormality requiring pregnancy termination in China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1020-1029. [PMID: 31919920 DOI: 10.1111/hsc.12935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
Family support is an important protective factor for pregnant women with a foetal abnormality and can prevent adverse psychological outcomes in this population. This study aimed to explore the importance and influencing factors of family support for pregnant women with foetal abnormalities requiring pregnancy termination and then determine the correlation between family support and women's post-traumatic stress symptoms. A mixed methods study was conducted from March 2016 to September 2017. In all, 214 participants were surveyed using self-reported questionnaires including the demographic, family and obstetric information questionnaire, the Family Adaptation Partnership Growth Affection and Resolve Index and the Impact of Event Scale-Revised to collect quantitative data. Semi-structured in-depth interviews with 28 participants were conducted to collect qualitative data. Of the pregnant women with foetal abnormalities, 35% had obstacles in family function such that family support was low. The Impact of Event Scale-Revised score was negatively associated with total score on the Family Adaptation Partnership Growth Affection and Resolve Index as well as the score for each item on this index. In terms of family support, the demographic, family and obstetric variables hierarchically entered into the regression models significantly explained 20.0%, 26.5% and 2.6% of variation, respectively. In addition, three key themes were identified based on qualitative analyses: intensified instrumental support, inadequate emotional support and insufficient informational support. The findings showed that family support plays a protective role in preventing post-traumatic stress symptoms following termination of pregnancy. At present, family support still needs to be improved, especially in emotional support and informational support. The factors influencing family support may be important to consider for improving family support.
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Affiliation(s)
- Shiwen Sun
- Department of nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengye Yang
- Department of Nursing, Suzhou Municipal Hospital, Suzhou, China
| | - Jieqiong Zhang
- Department of nursing, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Xiaoli Zhou
- Department of Nursing, Suzhou Municipal Hospital, Suzhou, China
| | - Ge Jia
- Department of Nursing, Medical college of Shihezi University. No, Shihezi, China
| | - Xiaoyan Yu
- Department of nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, China
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Psychosocial Profile and Reproductive Decisions of Women Undergoing Pregnancy Termination for Medical Reasons-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183413. [PMID: 31540023 PMCID: PMC6765807 DOI: 10.3390/ijerph16183413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The study aims to define the profile of women who decide to exercise their right to terminate a pregnancy and their future reproductive plans. METHODS Patients found eligible for termination for medical reasons between 2014 and 2016 were asked to complete an anonymous survey consisting of sixty questions examining the determinants of the decision to terminate a pregnancy. In total, 150 completed surveys were returned (62.5%). RESULTS Environmental factors, such as age, education, place of residence, marital status and financial status did not affect the decision-making process. The majority of the respondents were females under 35 years of age (71.3%). In most cases, the pregnancies had been planned and long-awaited (62.7%). The study also indicated that 22.6% of the patients who had been against abortion changed their mind when they encountered problems themselves. In addition, 20% of them changed their views on the acceptability of abortion. Termination had an impact on the participants future reproductive plans. Eighteen percent of the patients said they were definitely not planning more pregnancies. The majority (84.09%) of these women said that the reason was the traumatic experiences related to their pregnancy. CONCLUSIONS The personal experience of a pregnancy termination procedure changed women's opinions about pregnancy termination and modified further reproductive plans.
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