Translation and validation of the Perinatal Grief Scale in a sample of Greek women with perinatal loss during the 1st and 2nd trimester of pregnancy

Objective: To translate and validate the Perinatal Grief Scale (PGS) (short version) in a sample of Greek women with perinatal loss during the first and second trimester of pregnancy.

Methods: One hundred seventy-six women were approached a few hours after the loss. Along with the PGS, three more questionnaires were completed: the Edinburgh Postnatal Depression Scale (EPDS), the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI), in order to assess the convergent validity of the PGS.

Results: Total sample mean age was 34.1 years (SD?=?5.2). Mean values and Cronbach’s alpha coefficients for PGS subscales exceeded the minimum reliability standard of 0.70. Mean score for “Active grief” was 31.47 (SD?=?9.31), for “Difficulty Coping” was 23.13 (SD?=?7.54) and for “Despair” was 21.07 (SD?=?7.07). By applying Pearson’s correlation coefficients, PGS subscales positively correlated with scores on EPDS, STAI and HADS.

Conclusions: The PGS Greek version is a reliable instrument in terms of internal consistency and the Cronbach’s alpha coefficients are high. The Greek version of PGS can be a useful instrument for the detection of the psychological impact after a perinatal loss and it has implications for both scientific research and clinical routine.     

A Standard Perinatal Care Record in Canada: Justification,Acceptability and Feasibility

Use of a standard perinatal record will serve the needs of health care consumers and providers who require expedient communication of all aspects of care. The universal use of a standard record will provide accurate information on which to base health care policy and management strategies for health care planners and researchers. Acceptance of a standard record is dependent on involvement of all users of the record in its development, collection of high quality data and designation of a minimum data set for a national perinatal database. Experience in the Nordic countries has shown that a national standard record is feasible and serves well as a data collection instrument. The Canadian Perinatal Surveillance System is in the process of developing a standard perinatal record for Canada.     

Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial

Genital tract trauma after spontaneous vaginal childbirth is common, and evidence-based prevention measures have not been identified beyond minimizing the use of episiotomy. This study randomized 1211 healthy women in midwifery care at the University of New Mexico teaching hospital to 1 of 3 care measures late in the second stage of labor: 1) warm compresses to the perineal area, 2) massage with lubricant, or 3) no touching of the perineum until crowning of the infant's head. The purpose was to assess whether any of these measures was associated with lower levels of obstetric trauma. After each birth, the clinical midwife recorded demographic, clinical care, and outcome data, including the location and extent of any genital tract trauma. The frequency distribution of genital tract trauma was equal in all three groups. Individual women and their clinicians should decide whether to use these techniques on the basis of maternal comfort and other considerations.     

Interconceptional counseling after perinatal and infant loss

Historically, preconceptional health promotion has been recommended for all prospective parents to improve perinatal outcomes. Preconceptional health promotion and interconceptional counseling may be even more beneficial for parents who have had previous perinatal losses. Perinatal loss can be devastating, with long-term effects on subsequent pregnancies and children. A theoretical framework for interconceptional counseling after perinatal loss needs to be developed. Interconceptional counseling can give couples important information to improve outcomes, acknowledge fears and anxieties, evaluate genetic risks, facilitate grieving, and explore attachment and parenting issues.     

Childbirth and pelvic floor trauma

The issue of traumatic damage to the pelvic floor in childbirth is attracting more and more attention amongst obstetric caregivers and laypersons alike. This is partly due to the fact that elective caesarean section as a potentially preventative intervention is increasingly available and perceived as safe. As there is a multitude of emotive issues involved, including health economics and the relative roles of healthcare providers, the discussion surrounding pelvic floor trauma in childbirth has not always been completely rational. However, after 25 years of urogynaecological research in this field it should be possible to determine whether pelvic floor trauma in childbirth is myth or reality, and, if real, whether it matters for the pathogenesis of incontinence and prolapse. On reviewing the available evidence, it appears that there are sufficient grounds to assume that vaginal delivery (or even the attempt at vaginal delivery) can cause damage to the pudendal nerve, the inferior aspects of the levator ani muscle and fascial pelvic organ supports. Risk factors for such damage have been defined and variously include operative vaginal delivery, a long second stage, and macrosomia. It is much less clear, however, whether such trauma is clinically relevant, and how important it is in the aetiology of pelvic floor morbidity later in life.     

Perinatal factors associated with the neurologic impairment of children born preterm.

OBJECTIVE: To determine the perinatal risk factors of long-term neurologic impairment for preterm infants. METHODS: A case-control study was conducted with 60 neurologically impaired and 60 healthy children, all born prematurely. RESULTS: There was no relation between neurologic impairment and maternal pregnancy complications or prenatal steroid administration, bacteriologic content of cervical smear, fetal presentation, fetal heart rate, or mode of delivery. Cerebral palsy was associated with early neurologic signs, perinatal asphyxia, neonatal septicemia, abnormal brain ultrasound findings, prolonged interval between rupture of membranes and delivery, and multiple placental lesions. Children with minimal cerebral dysfunction were more frequently first born. Multiple placental lesions, neonatal septicemia, abnormal brain ultrasound findings, and perinatal asphyxia were independently correlated with long-term neurologic impairment. CONCLUSION: Perinatal infection, perinatal asphyxia, and abnormal brain ultrasound findings seem to be risk factors for cerebral palsy whereas primigravidity seems to be correlated with minimal cerebral dysfunction.     

Perinatal mortality associated with abruptio placenta in singletons and multiples

OBJECTIVE: This study was undertaken to investigate the association among plurality (number of fetuses per pregnancy), abruptio placenta, and perinatal mortality. STUDY DESIGN: A retrospective cohort study on 15,051,872 singletons, 413,619 twins, and 22,585 triplets delivered in the United States between 1995 and 1998 was conducted. We compared the occurrence of perinatal death between pregnancies complicated by abruptio placenta and those without with the use of adjusted odds ratios. The generalized estimating equations framework was applied to adjust for intracluster correlations among multiples. RESULTS: Placental abruption occurred among 93,968 singletons (6.2 per 1000), 5051 twin (12.2 per 1000), and 353 triplet (15.6 per 1000) gestations ( P for trend<.0001). Placental abruption was associated with significant risk of mortality irrespective of the plurality subtype. Perinatal mortality was greatest among singletons (adjusted odds ratio [95% CI]=14.3[13.2-15.4]), followed by twins (4.4[3.9-4.9]) and least among triplets (3.0[2.0-4.6]) ( P for trend<.0001). CONCLUSION: As plurality increases from 1 to 3, the risk of placental abruption rises, whereas the risk of abruptio-associated perinatal mortality declines.     

Born after infant loss: The experiences of subsequent children

Objective

to gain an in-depth understanding of subsequent children’s experiences of being born into and raised in a family following an infant death.

Design

an exploratory qualitative study.

Setting

semi-structured interview in the participants’ homes. Data were collected over a five-month period in 2009 and analysed using thematic analysis.

Participants

a purposive sample of 10 subsequent children (five boys and five girls) was used. Children whose parents had accessed the support services offered by two bereavement support agencies were recruited. Participants were asked to describe their experiences of being a subsequent child. Interviews were conducted when the subsequent child was at least 13 years of age.

Findings

all participants spent time describing how they felt about being a subsequent child. They described how they had experienced life as a subsequent child, how they considered others felt about them (especially their mother), and finally how they felt about their deceased sibling.

Key conclusions and implications for practice

all participants in this study provided a picture of emotional well-being. They were aware of their family history, and all appreciated the grief and loss which their parents had suffered. However, they did not believe that this had impacted negatively on them; rather, most talked about positive effects including feeling loved and special because of the circumstances resulting in their birth. Even those who recognised that they may not have been born had their sibling lived accepted this and appeared to be emotionally secure and well adjusted. These findings suggest that intervention with bereaved parents at the time of the perinatal/infant death and soon after is beneficial to the experiences of the subsequent child. Further research to determine the nature and extent of this benefit is warranted.     

Parenting paradox: Parenting after infant loss

Objective

to gain an in-depth understanding of the parenting experiences of bereaved parents in the years following an infant death.

Design

an exploratory qualitative study.

Setting

semi-structured interview in the participants’ homes. Data were collected over a five-month period in 2008 and analysed using thematic analysis.

Participants

a purposive sample of 13 bereaved parents (10 mothers and three fathers) was used. Parents who had accessed the support services offered by two bereavement support agencies were recruited. Participants were asked to describe their experiences of raising their subsequent child. Interviews were conducted when the next born child was at least three years of age.

Findings

the parents described a ‘paradoxical’ parenting style where they were trying to parent using two diametrically opposed unsustainable options. For example, they described trying to hold their subsequent child emotionally close but aloof at the same time.

Key conclusions and implications for practice

the results from this study indicate that the impact of a loss of an infant has far-reaching consequences on subsequent parenting. Support and early intervention at the time of the stillbirth and subsequent pregnancy are likely to be useful. However, further research is required to determine the extent to which early intervention can alter the tendency towards bereaved parents adopting a paradoxical parenting style. The impact of this style on mental health and the emotional health and well-being of the next born child/ren after perinatal loss should also be further examined.     

Restrained expectations in late pregnancy following loss

OBJECTIVE: To describe women's late pregnancy after loss experiences (from 25 weeks gestation to birth), document the timing and frequency of their common discomforts and events, and explore changes in these experiences over time. DESIGN: A longitudinal, qualitative study of pregnancy calendar entries and field notes. SETTING: Prenatal care providers and community canvassing in Central New York and the Internet. PARTICIPANTS: Pregnant women (N= 69) with a history of perinatal loss. MAIN OUTCOME MEASURES: Women's pregnancy calendar entries and field notes. RESULTS: Thematic data analysis yielded two main themes and several subthemes: (a) Precarious Pregnancy Security with subthemes of Informed Awareness and Varying Emotions and (b) Prudent Baby Preparations with subthemes of Physical, Social, and Emotional Preparation. CONCLUSION: Women reported an increased sense of security about the pregnancy and baby over time but this security was easily shaken. For women with a history of later or multiple loss, anxiety may remain high or increase as the due date approaches. Fetal movement is the most common barometer of fetal well-being during this part of pregnancy. With a better understanding of pregnancy after loss, clinicians can have a positive impact on women's prenatal experiences.     

Facilitating Milk Donation in the Context of Perinatal Palliative Care

The option to donate milk within the context of perinatal palliative care allows pregnant women to be involved in medical decision making before birth. In this article we examine how a perinatal bereavement program engages women and families in the process of milk donation when the deaths of their newborns are anticipated. We include two case examples to offer insight into the complexities within the patient experience of milk donation after perinatal loss.     

Trends in the Occurrence of Antenatal and Perinatal Complications with Increasing Parity

Purpose

In modern days, grand multiparity is confined to communities where contraception is not practiced because of social and religious beliefs. For this reason, it is quite prevalent in all GCC countries. Few studies have compared the outcomes between the three groups: low parity (2–4), grand multiparity (5–9), and great grand multiparity (10 and more) . This study intended to analyze the trends in the occurrence of various perinatal complications across these three groups.

Methods

This historical cohort study was conducted in Mafraq Hospital, Abu Dhabi between January 1, 2009 and December 31, 2011. There were 1,658 multipara, 1,198 grand multipara, and 160 great grand multipara.

Results

Different complications revealed different trends with increasing parity. Many antenatal and intrapartum complications like diabetes (overt and gestational), anemia, preterm delivery, malpresentation at term, postpartum hemorrhage, and macrosomia showed a linear increase with increasing parity, while some, like the need for labor augmentation and soft tissue injuries showed a declining trend with increasing parity. Interestingly, some complications like placenta praevia, need for induction of labor, cesarean delivery, and post-term delivery followed an inverted V curve, showing an increase in their occurrence up to parity nine but a decline thereafter with further increasing parity of ten or beyond.

Conclusion

Women in different parity groups were at risk of different complications. There are some complications which decrease with increasing parity, and perinatal mortality remains very low suggesting that in modern settings, with favorable socioeconomic conditions and access to high-quality healthcare, a satisfactory perinatal outcome can be expected with low morbidity and mortality.     

Impact of prior perinatal loss on subsequent pregnancies

OBJECTIVE: To evaluate the influence of previous perinatal loss on depressive symptoms, pregnancy-specific anxiety, and prenatal attachment for parents during subsequent pregnancies. DESIGN: Cross-sectional, survey design. PARTICIPANTS: Forty expectant couples who experienced a prior perinatal loss. Measures: Influence of loss (Impact of Event Scale [IES]), depressive symptoms (Center for Epidemiologic Studies-Depression Scale [CES-D]), pregnancy-specific anxiety (Pregnancy Outcome Questionnaire [POQ]), and prenatal attachment (Prenatal Attachment Inventory [PAI]). RESULTS: Mothers reported higher levels of depressive symptoms, pregnancy-specific anxiety, and prenatal attachment than fathers did. Forty-five percent of mothers and 23% of fathers had CES-D scores greater than or equal to 16 indicating high risk for depression. Eighty-eight percent of mothers and 90% of fathers reported elevated stress related to the prior loss (IES scores greater than or equal to 19). The impact of the previous perinatal loss was moderately correlated with depressive symptoms as well as pregnancy-specific anxiety. There was no relationship between the psychological distress in pregnancy after perinatal loss and prenatal attachment. CONCLUSIONS: The extent to which the impact of the prior loss increased parents' stress in the current pregnancy influenced their psychological distress. These findings should heighten awareness of the mixture of hope and fear expectant parents experience during pregnancies subsequent to perinatal loss.     

The Influence of Prior Perinatal Loss on Parents' Psychological Distress After the Birth of a Subsequent Healthy Infant

Objective: To evaluate the long-term influence of a previous perinatal loss on parents' psychological distress during a subsequent childbearing experience.
Design and Sample: A cohort design was used to examine 36 couples with a history of prior perinatal loss. Data were collected during the third trimester of pregnancy, 3 months postpartum, and again 8 months after birth.
Measures: Outcome measures included posttraumatic stress (The Impact of Event Scale), depressive symptoms (Center for Epidemiologic Studies-Depression Scale), anxiety (Spielberger State-Trait Anxiety Inventory), and parental concerns and attitudes (Maternal/Paternal Attitudes Questionnaire).
Results: Levels of depressive symptoms ( p <.001), anxiety ( p <.001), and posttraumatic stress ( p =.046) significantly decreased over time in this population. However, levels of posttraumatic stress remained in the moderate range even at 8 months after birth. Depression was significantly correlated with posttraumatic stress at each time point. In addition, depression was significantly related to posttraumatic stress, anxiety, and concerns parents had about their infant's well-being at T3.
Conclusion: While levels of anxiety and depressive symptoms decreased for parents who have experienced a previous perinatal loss, posttraumatic stress levels remained moderately high. It is unclear how this compares to parents without losses. These may be the unique symptoms and concerns these parents have about their new infant. Parents with a history of prior loss should have assessments carefully tailored to their experiences to anticipate continued psychological distress.     

妊娠合并哮喘与围产儿预后

目的 探讨妊娠合并哮喘及其病情控制程度与围产儿预后的关系。方法 对1990年1月至1999年12月间我院住院分娩的妊娠合并哮喘患者16例的临床资料进行回顾性分析。按病情控制程度分为发作组(9例)及缓解组(7例),并随机选取同期住院分娩的孕妇32例作为对照组,对3组新生儿出生体重、出生1分钟Apgar评分、羊水状况、早产及胎儿宫内发育迟缓(IUGR)等围产儿预后指标进行比较分析。结果 发作组新生儿出生体重低于缓解组及对照组(P<0.05),后两组差异无显著性(P>0.05);发作组剖宫产分娩、新生儿Ⅰ度窒息、IUGR及羊水异常的发生比例高于对照组(P<0.05);发作组早产的发生比例与后两组相比,差异无显著性(P>0.05);结论 妊娠合并哮喘时,病情反复控制不良者可导致多种围产儿并发症,需积极治疗减轻病情.改善围产儿预后。