A qualitative study exploring the needs related to the health system in women with experience of pregnancy termination due to fetal anomalies in Iran
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SUBMITTER: Kamranpour B
PROVIDER: S-EPMC7526095 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundExtensive application of screening tests for early diagnosis of fetal abnormalities would justify support for women who are facing pregnancy termination due to fetal abnormalities. Considering the lack of available information regarding supportive sources for these people, the present study was conducted to determine the supportive needs of women who have experienced pregnancy termination due to fetal abnormalities.MethodsThe present research was a qualitative study. The participants were selected using a purposeful sampling method with maximum variation. Data were collected through in-depth personal interviews and taking of field notes and were analyzed simultaneously using conventional content analysis.ResultsThe main categories that appeared in the present study included "support from the husband" with sub-categories of "mental support and necessary accompaniments", "participating in planning for future pregnancy" and "financial support to pay the costs of diagnosis and follow-up", "support from the family and friends" with sub-categories of "helping in taking care of other children", "help in performing daily activities" and "empathy, companionship and necessary support to maintain mental peace" and finally "support from peers" with sub-categories of "communicating with the peers and receiving information from them" and "creating a sense of confidence and hopefulness".ConclusionsResults of the present study, by determining and highlighting the supportive needs of women who have experienced pregnancy termination due to fetal abnormalities, could be an appropriate basis for providing effective strategies to improve constant participation of the husbands, family members and the peers along with other professional care.
| S-EPMC6500064 | biostudies-literature
Project description:BackgroundImproved 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 questionWhat are the healthcare experiences and needs of parents who undergo a termination of pregnancy following an antenatal diagnosis of a fetal anomaly?MethodsA 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.ResultsA 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.ConclusionCompassionate 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 registrationPROSPERO registration number: CRD42020175970 .
| S-EPMC9137204 | biostudies-literature
Project description:OBJECTIVE:This study aims to explore the perspectives of professionals around the issue of termination of pregnancy for non-lethal fetal anomaly (TOPFA). METHODS:Semi-structured interviews were undertaken with medical professionals (14 consultants in fetal medicine, obstetrics, neonatology and paediatrics) and social care professionals (nine individuals with roles supporting people living with impairment) from the Northeast of England. Analysis adopted an inductive thematic approach facilitated by NVivo. RESULTS:The overarching theme to emerge from the interview data was of professionals, medical and social care, wanting to present an acceptable self-image of their views on TOPFA. Professionals' values on 'fixing', pain and 'normality' influenced what aspects of moral acceptability they gave priority to in terms of their standpoint and, in turn, their conceptualisations of acceptable TOPFA. Thus, if a termination could be defended morally, including negotiation of several key issues (including 'fixing', perceptions of pain and normality), then participants conceptualised TOPFA as an acceptable pregnancy outcome. CONCLUSION:Despite different professional experiences, these professional groups were able to negotiate their way through difficult terrain to conceptualise TOPFA as a morally acceptable principle. While professionals have different moral thresholds, no one argued for a restriction of the current legislation. The data suggest that social care professionals also look at the wider social context of a person with an impairment when discussing their views regarding TOPFA. Medical professionals focus more on the individual impairment when discussing their views on TOPFA.
| S-EPMC5855171 | biostudies-literature
Project description:ObjectiveTo determine the frequency of diagnostic indications among women seeking to terminate pregnancies for reasons of fetal abnormality, spontaneous fetal demise, or a genetic disorder in a private outpatient clinic specializing in late outpatient abortion procedures.MethodA total of 1005 women requested termination of pregnancy for reasons of genetic disorder, fetal anomaly, or fetal demise over 20 years (1992-2012). Gestational ages ranged from 12 to 39 weeks. In all cases, a documented diagnosis of fetal abnormality or fetal demise was made prior to referral. Records were reviewed to verify fetal diagnosis for all patients seeking termination of pregnancy for reasons of fetal disorder. Major complications included major unintended surgery, hemorrhage requiring transfusion, or pelvic infection.ResultsPreoperative diagnoses included the following: chromosomal abnormalities (n = 378), genetic syndromes and single gene disorders (n = 30), structural anomalies (n = 494), and other conditions (n = 103). These include 26 cases of spontaneous fetal demise and nine selective terminations of one abnormal twin. The major complication rate was 0.5%.ConclusionsThe majority of diagnoses were in the categories of genetic disorder and neurologic abnormality.
| S-EPMC4238813 | biostudies-literature
Project description:BackgroundWith the extensive use of aspirin in obstetrics and reproductive medicine, concerns of potentially related congenital anomalies have been raised in previous studies. However, there is a lack of evidence concerning the safety of application of aspirin during pregnancy in Chinese population, especially during the first trimester.Patients and methodsWe retrospectively included a total of 2,763 patients with 2,856 fetuses (2670 singleton births and 93 pairs of twins), among whom 1,684 took low dose aspirin (LDA) during pregnancy (the LDA group) and the other 1,079 were not exposed to LDA (the control group). The primary outcome was the rate of fetal congenital anomalies, and was compared between the LDA group and the control group. We also conducted logistic regression to examine the potential risk factors of congenital abnormalities.ResultsThe average daily dose of LDA taken was 67.6 mg. The rate of congenital anomalies was comparable between the two groups, suggesting low teratogenicity of LDA application during pregnancy (3.3% vs. 2.8%; P = 0.421). The duration of LDA exposure and the time of LDA exposure showed no association with congenital anomalies. A previous history of fetal congenital anomalies was associated with an increased risk of the recurrence of congenital anomalies in the siblings (adjusted OR = 3.00, 95% CI: 1.00-8.60; P = 0.041).ConclusionExposure to LDA during pregnancy did not increase the risk of congenital anomalies in the fetus, suggesting that it was safe to apply LDA during pregnancy. A history of previous fetal abnormalities was found to be an independent risk factor of congenital anomalies. Our study suggests that LDA can be safely applied during pregnancy without increasing risks of congenital anomalies.
| S-EPMC9624035 | biostudies-literature
Project description:Background: Ethically controversial medical procedures, such as the termination of pregnancy, are frequently associated with a discrepancy between personal attitude and values versus requirements related to a professional situation. The study aimed to assess emotional complications in midwives participating in pregnancy termination procedures. Methods: The study included 181 midwives working in state-governed healthcare facilities in central and eastern Poland. The Oldenburg Burnout Inventory (OLBI) and the present authors' own questionnaire were used in the study. The results indicating the level of occupational burnout were presented in two scales: the exhaustion scale and the disengagement scale. Results: The study revealed that 48% of midwives had never participated in pregnancy termination procedures due to fetal defects. The level of occupational burnout described with the exhaustion factor (t = 2.06; p < 0.041) and disengagement factor (t = 2.96; p < 0.003) was significantly higher in the group of midwives participating in pregnancy termination procedures due to fetal defects than in the group of midwives who did not participate in pregnancy terminations. The most common factors contributing to burnout reported by midwives who participated in pregnancy terminations were: moral dilemmas (68%), seeing the aborted fetus (65%), anticipating the child's death in case it was born with signs of life (59%) and the lack of professional psychological support for medical personnel (56%). Conclusions: Importantly, pregnancy termination should be performed by persons who find such procedures acceptable from the viewpoint of their value system. It is a protective factor in regards to work with women who undergo terminations. Moreover, developing a system of informational and psychological support for midwives participating in pregnancy termination procedures is also a significant aspect.
| S-EPMC7216072 | biostudies-literature
Project description:BackgroundFetal cells (microchimerism) are acquired by women during pregnancy. Fetal microchimerism persists decades later and includes cells with pluripotent capacity. Persistent microchimerism has the capacity for both beneficial and detrimental maternal health consequences. Both miscarriage and termination of pregnancy can result in fetal microchimerism. We sought to determine whether cellular fetal microchimerism is acquired during management of pregnancy loss and further explored factors that could influence fetal cell transfer, including viability of fetal tissue, surgical versus medical management and gestational age.MethodsPregnant women (n= 150 samples from 75 women) with singleton pregnancies undergoing a TOP (n= 63) or treatment for embryonic or fetal demise (miscarriage, n= 12) were enrolled. Mononuclear cells were isolated from blood samples drawn before, and 30 min after, treatment. Fetal cellular microchimerism concentrations were determined using quantitative PCR for a Y chromosome-specific sequence, expressed as genome equivalents of fetal DNA per 100 000 maternal cell equivalents (gEq/10(5)). Detection rate ratios were determined according to clinical characteristics.ResultsCellular fetal microchimerism was found more often in post- compared with pretreatment samples, 24 versus 5% (P= 0.004) and at higher concentrations, 0-36 versus 0-0.7 gEq/10(5) (P< 0.001). Likelihood of microchimerism was higher in surgical than medical management, detection rate ratio 24.7 (P= 0.02). The detection rate ratio for TOP versus miscarriage was 16.7 for known male fetuses (P= 0.02). Microchimerism did not vary with gestational age.ConclusionsSignificant fetal cell transfer occurs during miscarriage and TOP. Exploratory analyses support relationships between obstetric clinical factors and acquisition of fetal cellular microchimerism; however, our limited sample size precludes definitive analysis of these relationships, and confirmation is needed. In addition, the long-term persistence and potential consequences of fetal microchimerism on maternal health merit further investigation.
| S-EPMC3415291 | biostudies-literature
Project description:BackgroundPregnant women with suspected fetal anomalies experience a great deal of stress following prenatal screening tests. The present study aimed to investigate women's worries about prenatal screening tests suspected of fetal anomalies.MethodsThrough the use of qualitative content analysis, the reports of women whose prenatal screening tests were suspected of fetal anomalies were analyzed and the results were interpreted. The participants were selected from four public and private maternity care clinics of Babol, Iran, from December 2021 to January 2022, using targeted convenience sampling. Data were collected from 20 women aged 24 to 41 years old, who underwent prenatal screening tests and were suspected of fetal anomalies, using semi-structured face-to-face interviews.ResultsThe four main themes included the "causes of worries" (with sub-themes of challenge with spouse and relatives, medical diagnosis processes, previous unpleasant experiences, physical and mental problems, financial worries, and misinformation), "anxiety-coping styles" (with cognitive emotion-oriented, behavioral emotion-oriented, and problem-oriented sub-themes), "reactions to a possible diagnosis of anomaly" (with three sub-themes, namely concealment, extreme fear and worry, and denial), and "attribution of the cause of the anomaly" (with sub-themes of consanguine marriage, evil eyes, tendency to have a baby of a particular gender, a history of anomalies in the previous child, the spouse's medical illness, unplanned pregnancy, and high maternal anxiety).ConclusionWomen with suspected fetal anomalies experience a great deal of stress, the most important reason for which is the "physician's uncertainty". "Sharing worries with relatives" was the most common style of coping with worries. Establishing emotional support and empathetic communication between midwives and physicians with pregnant women suspected of fetal anomalies were important ways to reduce their worries.
| S-EPMC9926685 | biostudies-literature
Project description:Background: Access to pregnancy-related information is an important requirement for all pregnant women, especially women at risk, such as immigrants. Regarding this, the present study was conducted to determine the information needs during pregnancy and its associated factors in the Afghan pregnant women. Methods: This cross-sectional study was conducted on 280 Afghan pregnant women who received care at the prenatal clinics of selected health care centers in the southeast of Tehran in 2018. The study population was selected using the continuous sampling method. The sampling was performed through the continuous sampling method from all the Afghan pregnant women who received care at the prenatal health centers of the southeast of Tehran. Results: Among the information needs during pregnancy, the fetal (83.34 ± 20.65) and smoking (62.61 ± 28.88) domains had the highest and lowest mean scores by percentage, respectively. The information needs during pregnancy showed a statistically significant relationship with age, women's education level, husband's education level, duration of living in Iran, place of residence, insurance status, number of children, place of the previous delivery, and routine prenatal care. Based on the multiple regression model, only the place of birth and place of residence accounted for 19% of information needs during pregnancy. Conclusion: As the findings indicated, the prenatal care-related education should address the domains that are unknown for Afghan women. Furthermore, in this education, the demographic and reproductive characteristics of the recipients should be taken into account to improve the pregnancy outcome among this population.
| S-EPMC7031785 | biostudies-literature
Project description:BackgroundThe implementation of molecular karyotyping has resulted in an improved diagnostic yield in the genetic diagnostics of congenital anomalies, detected prenatally or after the termination of pregnancy. However, the systematic epidemiologic ascertainment of copy number variations in the etiology of congenital anomalies has not yet been sufficiently explored.MethodsConsecutive fetuses, altogether 204, with major single or multiple congenital anomalies were ascertained by using the SLOCAT registry for the period from 2011 to 2015. After excluding aneuploidies by using conventional karyotyping or Quantitative Fluorescence-Polymerase Chain Reaction, array comparative genomic hybridization was performed for the detection of copy number variations.ResultsWe identified pathogenic or likely pathogenic copy number variations in 14 fetuses (6.8%); 2.9% in fetuses with isolated, and 3.9% in fetuses with multiple congenital anomalies. Additionally, aneuploidies and major structural chromosomal abnormalities were detected in 40.2%.ConclusionOur systematic approach of ascertaining congenital anomalies resulted in explaining the etiology of congenital anomalies in 47% of fetuses after the termination of pregnancy. By using array comparative genomic hybridization, we found that copy number variations represent an important part in the etiology of multiple, as well as isolated congenital anomalies, which indicates the importance of analyzing copy number variations in the diagnostic approach of fetuses with congenital anomalies after the termination of pregnancy.
| S-EPMC6565594 | biostudies-literature