Successfully reported this slideshow.

More Related Content

Related Audiobooks

Free with a 14 day trial from Scribd

See all

Online Rez Solutions

  1. 1. PERINATAL LOSS AND GRIEF Erin Kelly Veronica Lopez
  2. 2. Tribute to my miscarriage 2
  3. 3. EXPECTED INDIVIDUAL STUDENT LEARNING OUTCOMES • Define perinatal loss • Define the different types and frequency of occurrence • Identify risk factors for perinatal loss • Identify signs and symptoms of perinatal loss • Describe emotional responses • Describe the process of grief and mourning • Nursing diagnoses and interventions 3
  4. 4. DEFINITION per·i·na·tal loss [per-uh-neyt-l] [laws, los] –noun The nonvoluntary end of a pregnancy from conception, during pregnancy, and up to 28 days of the newborn’s life. Also referred to as pregnancy loss. 4
  5. 5. TYPES • Ectopic Pregnancy • Miscarriage • Stillbirth • Neonatal Death 5
  6. 6. ECTOPIC PREGNANCY • Implantation occurs outside of the uterus • The baby (fetus) cannot survive • Caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus (hormonal factors, smoking) • Signs: abdominal pain, GI symptoms, vaginal bleeding, weakness, dizziness, fainting • Diagnosis: pelvic exam, ultrasound, measurement of hCG levels • Risk Factors: multiple sex partners, Age >35, In vitro fertilization • Most common complication is rupture with internal hemorrhage 6
  7. 7. MISCARRIAGE • Most common type of pregnancy loss often referred to as “spontaneous abortion” or SAB ▫ 10-25% of clinically recognized pregnancies will end in miscarriage • Occurs in ≤20 weeks gestation • Most often the cause cannot be identified ▫ Chromosomal abnormalities, hormonal problems, lifestyle, maternal age, maternal trauma • Warning signs: mild to severe back pain, weight loss, white-pink mucus, true contractions, brown or bright red vaginal bleeding, tissue with clot like material passing through the vagina • Types: Threatened, Incomplete, Complete, Missed, Recurrent • Blighted Ovum ▫ Fertilized egg attaches to the uterine wall but the embryo DOES NOT develop 7
  8. 8. STILLBIRTH • Late pregnancy loss • Occurs >20 weeks gestation • 1 in 160 pregnancies • The majority take place before labor • Causes: placental problems, birth defects, growth restriction, infections • Risk Factors: Age >35, malnutrition, inadequate prenatal care, smoking, drug and alcohol abuse • Prevention: daily kick counts, avoid certain substances, contact HCP if notice vaginal bleeding 8
  9. 9. NEONATAL DEATH • Loss occurring from birth to 28 days of life ▫ The baby has demonstrated signs of life including breathing, heart beating, pulsations of umbilical cord, and movement of voluntary muscles • Most common cause is premature birth (before 37 weeks gestation) ▫ RDS (Respiratory Distress Syndrome) ▫ Intraventricular Hemorrhage ▫ Infection ▫ Necrotizing Enterocolitis • Other Causes: birth defects (heart, lung, brain, spine), complications of pregnancy, complications involving the placenta, infections, asphyxia 9
  10. 10. FREQUENCY • Perinatal Loss occurs in 1 million women every year in the United States ▫ It is very common • Early Losses(≤20 weeks): up to 25% of all conceptions • Late Losses (>20 weeks): 2%-4% of pregnancies • Rates of pregnancy loss have remained the same, but stillbirth rates have declined 10
  11. 11. EMOTIONAL RESPONSES • Research findings indicate that there are differences in grief responses according to sex. • Mothers often experience intense responses, including extreme sadness; guilt; suicidal ideation; and feelings of emptiness, isolation, irritability, and anger. • Some mothers had difficulty being around pregnant women and infants or in situations such as holiday celebrations that reminded them of what might have been had their infant survived. • Fathers also experience a range of feelings, including isolation, restlessness, anger, sadness, and powerlessness. • Fathers are often concerned for their partner’s emotional well-being. 11
  12. 12. TREATMENT • Hormone Therapy ▫ Progesterone • If Maternal Autoimmune or clotting disorders are known, Heparin or other drugs can be administered • Emotional Treatment • Prevention Measures: exercise, healthy eating, manage stress, folic acid supplements, quit smoking 12
  13. 13. GRIEF AND MOURNING • When a baby dies, parents must work through profound grief related to the loss of their child along with the loss of their hopes and dreams for that child and their family. • Grief is individual in nature. • Stages of grief: ▫ Avoidance, disbelief, shock. ▫ Pain, physical discomforts, depression, difficulty concentrating, anger at self or partner, guilt. ▫ Acceptance and adaptation. Grief persists, but a sense of balance is achieved. 13
  14. 14. NURSING DIAGNOSIS I • Ineffective sexuality pattern r/t to self-esteem disturbance resulting from pregnancy loss and anxiety about future pregnancies. 14
  15. 15. NURSING INTERVENTIONS • After establishing a relationship with the patient, give them permission to openly discuss issues dealing with sexuality. Ask specific questions, starting with general ones before getting personal. • Use assessment questions and standardized instruments to assess sexual problems. • Encourage the patient to discuss concerns with their partner. • Assess psychological function such as anxiety, depression, and low self-esteem. • Discuss alternative sexual expressions for altered body functioning or structure. 15
  16. 16. NURSING DIAGNOSIS II • Complicated grieving r/t to sudden loss of pregnancy, fetus, or child. 16
  17. 17. NURSING INTERVENTIONS • Assess the patient’s state of grieving. ▫ Tools: Texas Revised Inventory of Grief (TRIG), Pathological Grief Items (PGI), Hogan Grief Reaction Checklist (HGRC). • Develop a trusting relationship with patient by using presence and therapeutic techniques. • Identify problems of eating and sleeping; ensure that basic human needs are being met. • Determine whether the patient is experiencing depression, suicidal tendencies, or other emotional disorders. • Educate the patient and their support systems on the grieving process and how it is individual. • Refer for appropriate support. 17
  18. 18. OTHER IMPORTANT INTERVENTIONS • Allow parents to express their feelings by being present and listening. • Express empathy and condolences. If the baby had been named, refer to them by that name. • AVOID clichés: “at least you are young, you can have another baby.” • Provide anticipatory guidance and educate about the process of grieving and what to expect physically and emotionally. • Refer parents to community services and support groups that may assist in facilitating the grief process. • Provide parents with memorabilia related to their baby, such as pictures, blankets, a cap, lock of hair, ID bracelet and crib card, foot/hand prints. • It is important to keep in mind that grief is individual. (culture, religion, personal experience, beliefs, etc..) 18
  19. 19. NURSING JOURNAL ARTICLE Supporting Parents After Stillbirth or Newborn Death. There is much that nurses can do. Karen Kavanaugh, PhD, RN, FAAN, and Teresa Moro, AM, LSW • Most widely known theory of grief: Kubler-Ross model • Swanson’s middle-range theory of caring. • Nonverbal support is communicated through eye contact, attentive listening, and concerned facial expressions. • Eliciting, listening to, and respecting parents’ needs and wishes must be paramount. • Parents, siblings (regardless of age), friends, and extended family members should have unrestricted time with the infant before and after the death and the opportunity to perform caregiving activities, such as bathing and dressing. • Nurses themselves need to be informed and provide written information about burial, autopsy, and organ donation options within their institution and community. • Follow-up visits are an important aspect of care, and phone calls should be made within one week of a loss and again several weeks later. • Nurses may also grieve. Working with many bereaved families in a short period of time can lead to chronic, compounded grief, which may limit nurses’ ability to continue caring for these families. 19
  20. 20. 20 Rights of Parents When an Infant Dies • To be given the opportunity to see, hold, and touch their Rights of the Infant infant at any time before and after death, within reason. • To be recognized as a person who was born and • To have photographs taken of their infant, and made available has died. to the parents or held in a secure place until the parents • To be named. wish to see them. • To be seen, touched, and held by the family. • To be given as many mementos as possible—for example, • To have the end of life acknowledged. crib card, baby beads, ultrasound or other photos, lock of • To be put to rest with dignity. hair, foot- and handprints, and measurement records. • To name their child and bond with him or her. • To observe cultural and religious practices. • To be cared for by empathetic staff who will respect their feelings, thoughts, beliefs, and individual requests. • To be with each other throughout hospitalization as much as possible. • To be given time alone with their infant, allowing for individual needs. • To request an autopsy. In the case of miscarriage, to request to have or not to have an autopsy or pathology examination as determined by applicable law. • To have information presented in understandable terminology regarding their infant’s status and cause of death, including autopsy and pathology reports and medical records. • To plan a farewell ritual, burial, or cremation in compliance with local and state regulations and according to their personal beliefs or religious or cultural traditions. • To be provided with information on resources that assist in the healing process—for example, support groups, counseling, reading material, and perinatal loss newsletters.
  21. 21. INTERVIEWS • How many times have you experienced a perinatal loss? • How far along were you? • Was there a specific cause? • How did you feel when you first found out you were pregnant? • How did you feel when you found out there was a loss? • What is/was the hardest part? • How has your life changed since it happened? • What did you do to cope? • What are you doing now? 21
  22. 22. RESOURCES FOR THOSE SUFFERING • • Pregnancy Loss and Infant Death Alliance ▫ • RTS Perinatal Bereavement Program ▫ • Associated for Death Education and Counseling ▫ 22
  23. 23. What is the MAIN cause of perinatal loss? A. Genetic Issues B. Lifestyle Choices (ie: drugs and alcohol) C. Hormone Levels D. Chromosomal Abnormalities E. All of the above, there is no main cause. 23
  24. 24. TRUE OR FALSE Grief is sequential. Most common type of pregnancy loss is miscarriage. Perinatal loss is uncommon. Nurses also grieve for their patient. 24
  25. 25. QUESTIONS?
  26. 26. SOURCES Ackley, B.J., & Ladwig, G.B. (2011). Nursing diagnosis handbook: an evidence-based guide to planning care. St. Louis, MO: Mosby Inc. Chapman, L, & Durham, R. (2010). Maternal-newborn nursing: the critical components of nursing care. Philadelphia, PA: F.A. Davis Company. Kavanaugh, K., & Moro, T. (2006). Supporting parents after stillbirth or newborn death. American Journal of Nursing, 106(9), 74-79. Loss and grief. (2008, October). Retrieved from 26