Background Second trimester miscarriage is defined as pregnancy loss after 12 weeks and before 24 weeks gestation. The care that parents receive has been shown to greatly influence the woman's recovery after pregnancy. Aims To explore parents' experiences of hospital care during a second trimester miscarriage, from the time of diagnosis through to follow-up care. Methods A focused ethnographic design to conduct semi-structured interviews with 14 bereaved parents before thematic data analysis. Findings Parents highlighted the need for effective medical care in relation to medical treatment, pain relief and length of hospital stay, going home to prepare for the delivery and follow-up care. Parents emphasised the importance of appropriate facilities and being separate from other parents and babies. Clear communication and finding a cause for their miscarriage was also important for parents. Conclusion Second trimester miscarriage is a significant life event for parents. Effective, individualised clinical care is needed to meet the medical needs of bereaved parents.
Background Second-trimester miscarriage is defined as pregnancy loss after 12 and before 24 weeks' gestation. Little is known about parents' experiences of hospital care during a second trimester miscarriage in Ireland. Aims This study aimed to explore parents' experiences of hospital care during a second-trimester miscarriage. Methods A focused ethnographic design was used. A series of semi-structured interviews were completed with 14 bereaved parents. The data were analysed using thematic network data analysis. Findings This paper discusses the global theme of relational and social experiences of miscarriage. Parents highlighted the need for compassionate care and expressed the importance of empathy and sensitivity from hospital staff to avoid further distress. Conclusions Compassionate care received by bereaved parents positively influenced their hospital experience, whereas a perceived lack of compassion or insensitivity had a lasting negative impact on bereaved parents.
The death of a baby, whether before, during or after birth is extremely sad. Mothers who were expecting a new life find themselves dealing with death. Midwives are one of a few people to share the important memory of the birth and death of a baby; therefore, the quality of care offered during this period is crucial to support mothers and limit the distress experienced at this difficult time. Emotionally, mothers require compassionate and sensitive care from midwives and health professionals, while physically the bereaved mother will require support and advice with her postnatal needs, as her body recovers from childbirth. The importance of knowledge and understanding of grief theory and the grieving process will guide midwives as they support the bereaved postnatal mother.
Objectives COVID-19 vaccine responses in rare autoimmune rheumatic diseases (RAIRD) remain poorly understood, in particular there is little known about whether people develop effective T cell responses. We conducted an observational study to evaluate the short-term humoral and cell-mediated T cell response after the second SARS-CoV-2 vaccination in RAIRD patients compared with healthy controls (HC). Methods Blood samples were collected after the second dose and anti-spike, anti-nucleocapsid antibody levels and SARS-CoV-2 specific T cell responses were measured and compared with HC. Activation induced marker and deep phenotyping assays were used to identify differences in T cells between high and low/no antibody groups, followed by multi-dimensional clustering. Results 50 patients with RAIRD were included (31 with AAV, 4 with other systemic vasculitis, 9 with SLE and 6 with myositis). Median anti-spike levels were significantly lower in RAIRD compared with HC (p< 0.0001). 15 (33%) patients had undetectable and 26 (57%) had lower levels than the lowest HC. Rituximab in the last 12 months (p= 0.003) was associated with reduced immunogenicity compared with a longer pre-vaccination period. There was a significant difference in B cell percentages (p= 0.03) and spike-specific CD4+ T cells (p= 0.02) between no/low antibody vs. high antibody groups. Patients in the no/low antibody group had a higher percentage of terminally differentiated (exhausted) T cells. Conclusions Following two doses, most RAIRD patients have lower antibody levels than the lowest HC and lower anti-spike T cells. RAIRD patients with low/no antibodies have diminished numbers and poor quality of memory T cells which lack proliferative and functional capacities.
Results suggest the incidence of mid-trimester loss may be slightly lower than the 1 or 2 % of pregnancies reported in the literature. The incidence of mid-trimester loss in multiparous women is approximately twice that of nulliparous women. The referral services offered in the study were utilised by most of the women, as were follow-up clinic appointments.
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