Kilcullen Meegan, Kandasamy Yogavijayan, Watson David, Cadet-James Yvonne
College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.
Department of Neonatology, The Townsville Hospital, Townsville, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2020 Jun;60(3):350-354. doi: 10.1111/ajo.13052. Epub 2019 Oct 7.
The stillbirth rate for Australian Aboriginal and Torres Strait Islander infants is twice that for non-Indigenous infants. Autopsy is the gold standard for fetal investigation; however, parental consent is often not given. There is little research investigating the drivers of parents' decision-making for autopsy after stillbirth.
The current study explored the reasons why Aboriginal and Torres Strait Islander women did or did not give permission to autopsy after stillbirth.
Five Aboriginal and/or Torres Strait Islander women participated in semi-structured interviews. Thematic analysis was conducted within a phenomenological framework.
Five themes were identified as reasons for giving permission - to find out why the baby died; to confirm diagnosis; to understand future risk; to help others; and doubt about maternal causes. Four themes were identified as reasons for declining permission - not asked in a sensitive manner; not enough time to think; distress about the autopsy procedure; and unwilling to agree. There was a lack of acceptability of the lengthy timeframe for the availability of autopsy results as families usually wait between three and nine months. This lengthy waiting period negatively impacted upon families' health and wellbeing.
It is important for health professionals to understand the factors that parents consider when giving permission for autopsy after stillbirth. It is hoped that an increase in autopsy rate will enhance the understanding of the causes of stillbirth and ultimately decrease the stillbirth rate for Aboriginal and Torres Strait Islander families.
澳大利亚原住民和托雷斯海峡岛民婴儿的死产率是非原住民婴儿的两倍。尸检是胎儿调查的金标准；然而，家长往往不同意。关于死产后家长决定是否进行尸检的驱动因素的研究很少。
本研究探讨了原住民和托雷斯海峡岛民妇女在死产后同意或不同意进行尸检的原因。
五名原住民和/或托雷斯海峡岛民妇女参与了半结构化访谈。在现象学框架内进行了主题分析。
确定了五个同意进行尸检的原因主题——找出婴儿死亡原因；确认诊断；了解未来风险；帮助他人；以及对母亲病因存疑。确定了四个拒绝同意的原因主题——询问方式不敏感；没有足够时间思考；对尸检程序感到痛苦；以及不愿意同意。尸检结果出具时间过长缺乏可接受性，因为家庭通常要等待三到九个月。这种漫长的等待期对家庭的健康和幸福产生了负面影响。
卫生专业人员了解家长在死产后同意进行尸检时考虑的因素很重要。希望尸检率的提高将增进对死产原因的了解，并最终降低原住民和托雷斯海峡岛民家庭的死产率。
